BIPOLAR AFFECTIVE DISORDER …that extreme excitement could be a tell- tale sign of an imminent mental breakdown

As a fresh resident psychiatrist, Bipolar Affective Disorder was the first mental illness to intrigue me. The story I will share here was the first of what would later become many of my encounters with people who are burdened with this illness. 

This experience, which actually happened to a close friend, led me to writing and blogging about mental illness.

John really felt good with himself because he thought he had finally overcome his shy nature. He could now walk up to any lady and chat with them because he felt he was irresistibly charming. He was full of energy and had earlier disclosed to me that he had discovered that “great men don’t have need for much sleep”. He was so excited about all the great ideas rushing through his mind and he went on and on talking… like forever. None of this new behavior stared up any need for concern from his family members until he did something…something really embarrassing and he had to be admitted into a psychiatric ward.

John (not real name) has a condition called Bipolar Affective Disorder, which refers to a disturbance in the mood of an individual. Though we don’t have the exact figure here in Nigeria the lifetime prevalence (will occur at some point in a person’s life) is between 0.3 and 1.5% of most general population.

What is Bipolar Affective Disorder?

Like the name implies “Bi” meaning two… there are 2 poles or sides to the illness, the individual with bipolar affective disorder is either sometimes “manic” or at other times “depressed” hence it’s commonly called a Manic-Depressive disorder.

There are two major variants of bipolar affective disorder; Bipolar I and Bipolar II.

In bipolar I the individual experiences one or more manic episodes with or without obvious depressive episodes in between while in the bipolar II variant the individual experiences repeated episodes of major depression interspersed with hypomanic episodes. Bipolar disorder generally shares the same incidence (rate of new cases) between both sexes however the bipolar II variant is more common in women.

How to recognize it?

Though there are two poles to this condition, in this edition I’ll be focusing on recognizing the manic pole. Mania is characterized by elated (happy) mood which would have lasted for at least one week with three or more of the following

   Self-esteem: highly inflated, grandiose; believing their ideas and works are exceptional

       Sleep: decreased need for sleep, rested after a few hours

  Speech: They are usually talkative; talking loudly, rapidly and endlessly making it impossible to interrupt them.

     Thoughts: racing thoughts moving very fast from one topic to another.

  Attention: easily distracted. They start many activities but would usually leave them unfinished as new ones catch their fancy.

    Spend extravagantly

    Display over familiarity even with strangers

   Sexual desires are increased and behavior may be uninhibited; may neglect precautions against pregnancy without the slightest awareness of the consequence of the behaviour.

Hypomania is a milder form of mania with all the above symptoms however the duration for the elated mood or irritability could just be as short as 4days. In milder forms of the illness the manic individual feels they are having an exhilarating experience; a feeling of being invincible, all powerful, and all-wise however the situation often worsens and then the condition becomes frighteningly out of control.

The Cause

Genetic and family studies show it runs in families however it could be triggered by environmental stressors and there is also evidence that depriving oneself of sleep could trigger it especially in those who are already vulnerable to this illness.

The Course (how it progresses)

For bipolar patients, the mean age the illness shows up for the first time is about 18years this is usually mild and may go unnoticed, the individual may get better without treatment. The mean age for first treatment is about 22years, and the mean age for the first hospitalization is about 25years. 25-50% of people with this illness also usually attempt suicide at least once especially during one of their depressive episodes.

In between episodes of the illness these individual are perfectly okay and can carry out their usual duties effectively. It has affected many creative people in the past and present hence it is nicknamed ‘creative madness’, though those who battle with this illness would rather live a ‘normal life’ and be free from the unpredictable mood swings.

Self Help Tips

These few tips could help reduce the chance of frequent reoccurrences in those already diagnosed with the illness and generally improve their quality of life

  Setting and maintaining a standard bedtime and wake time this is to prevent sleep deprivation which may trigger the illness

    Practicing relaxation or meditation exercises regularly

    Reducing work and family stress as much as is practical

   Eating a healthy diet at regular times each day as excessive fasting tends to trigger it too

Regular participation in communities including religious communities;   community participation helps prevent depression

   Taking medication at the same time everyday

   Regular attendance at clinical appointments and regular self-monitoring

    Avoidance of mood-altering drugs, including alcohol

Coping with those with the Illness

Like every chronic illness there is a lot of emotional and financial strain placed on family and friends. The spontaneity of the reckless behaviour of these individual in terms of excessive spending, suicidal attempts, promiscuity and general odd behaviour may cause a form of embarrassment and anxiety.
To cope with the ones with the illness and also better assist them one should

    Get information about the nature of the illness so they can help monitor the individual’s mood thereby being able to detect early onset of the illness and possibly initiate intervention when necessary.

  Encourage these individuals to comply with medication since most of them have a tendency to stop their drugs complaining that they don’t like the way the drugs make them feel.

  Develop an ongoing relationship with a family therapist who can provide advice and crisis management services.

Limit the patient’s access to large money possibly by introducing co-signatory modalities.

Long acting birth control methods can be used to reduce the risk of unwanted pregnancy.

  Regular testing for sexually transmitted disease for patient and spouse when sexual promiscuity is involved.

       Find a support group (could be a religious group) that could always give the needed support when you feel like giving up.

Please bear in mind that these individuals did not bring the illness upon themselves so be gentle on them and if you suffer from this illness I encourage you to comply with your medication and maximize your quality of life.

Please check out this link http://www.youtube.com/watch?feature=player_detailpage&v=rqoj7Mse7iQ