I. Concept: Bipolar disorder, also known as bipolar disorder, is a type of mood disorder with both manic or hypomanic episodes and depressive episodes. Most patients have a tendency to have recurrent episodes, and some may have residual symptoms or become chronic. In severe cases, psychotic symptoms such as hallucinations, delusions or catatonic symptoms may occur at the peak of the attack. Each episode often lasts for a considerable period of time and has a negative impact on daily life and social functioning.
Second, the damage of bipolar disorder on the brain.
1, structural imaging studies: most CT studies found that the ventricles of the brain in patients with bipolar disorder are larger than in normal controls. The incidence of ventricular enlargement was 12.5% to 42%. Some patients had partial gray matter degeneration and volume reduction in some brain regions.
2. Functional imaging studies: some depressed patients were found to have reduced local blood flow in the left frontal lobe and reduced blood flow in the left anterior cingulate gyrus, and the degree of reduction was positively correlated with the severity of depression.
III. Clinical manifestations
(A) Manic episode: The typical clinical symptoms are high emotion, running thoughts and increased activities.
1. Emotional exaltation: Patients feel particularly happy, feel good about themselves, relaxed, carefree, smiling, cheerful, no difficulties, and some people show that they lose their temper (irritable) because of a small matter.
2, the thinking of the runaway: thinking association accelerates, speech increases, the export of words, the endless, rich, witty and humorous, the patient himself feels that the brain becomes very sensitive, intelligent, rapid response. They feel good about themselves, exaggerate their own ability, wealth and status, and think they have the ability to do great things and earn big money.
3. Increased activity: Patients are more active, good at socializing, good at minding their own business, wanting to do big things, wanting to do many things. Energetic, sleep needs to be reduced, do not know tired. Do things without end, easy to divert attention, rash behavior, regardless of the consequences. Good at spending money and seeking pleasure. Easily conflict with the surrounding area, increased sexual desire and rash sexual behavior. When the manic state is severe, it may show incoordination symptoms, speech and behavior disorder, hallucinations, delusions and other psychotic symptoms. Often have no ability to recognize their condition and do not think they have a disease.
(II) Depressive episodes.
1, depressed mood: patients lack of interest, no sense of cheerfulness, happy, fatigue, energy decline, daytime anxiety, depression, sadness, long and short sighs, feeling no confidence in the future, lazy life, passive behavior. In more severe cases, there may be hallucinations, delusions and other symptoms, pessimism and despair, anorexia. This is often accompanied by anxiety symptoms such as worry, nervousness, irritability, and somatic discomfort.
2. Delayed thinking: The patient’s speech is reduced, voice is low, reaction is slow, thoughts are closed, and he feels that “his brain seems to be a rusty machine” or “his brain is not open like a paste”, and his ability is reduced.
3. Decreased voluntary activity: slow behavior, passive and lazy life, not wanting to do anything, bedridden, not wanting to go to work, not wanting to go out, avoiding social life. In severe cases, even eating, drinking and personal hygiene are disregarded.
4, somatic symptoms: very common, there are serious insomnia, appetite disorders, lack of energy, decreased sexual function, weight loss, general irregular pain, amenorrhea and many other somatic discomfort, the symptoms are aggravated in the morning.
Fourth, the disease burden and harm of bipolar disorder The disease burden of bipolar disorder is very high, the relapse rate is high, and the prognosis for repeated episodes is worse.
Fifth, depression has the following characteristics to pay high attention to the emergence of potential bipolar disorder.
1, early onset ;
2, depression frequent episodes, and episodes of short duration;
3, bipolar disorder first-degree relatives family history;
4, pre-morbid with affective exuberance and (or) cyclothymic and (or) borderline personality disorder;
5, seasonal mood changes;
6, poor efficacy of previous antidepressant treatment and/or rapid change in mood after treatment and/or induced mania or hypomania;
7, excessive sleep and/or daytime sleepiness;
8. Bulimia or weight gain;
9. Psychomotor retardation;
10. Psychotic symptoms;
11.Postpartum depression.
Six, the long-term treatment principles of bipolar disorder
1, the principle of comprehensive treatment: medication, physical therapy, psychotherapy (including family therapy) and crisis intervention measures should be used in combination.
2, long-term treatment principles: bipolar disorder almost lifelong recurrent episodes in a cyclic manner, the frequency of episodes is much higher than depressive disorder, often in a chronic process, should adhere to long-term treatment.
Seven, bipolar disorder prognosis of the reasons for poor.
1, high relapse rate: more than 90% of recurrent episodes;
2, high suicide rate: 25% to 50% of suicide attempts, 11% to 19% of suicide deaths;
3, high co-morbidity rate: 46% with alcohol dependence, 60% with drug dependence;
4. High disease burden.
VIII. Factors affecting the maintenance of treatment adherence.
1. Disease factors: substance abuse, previous hospitalization, psychotic symptoms, and decreased disease insight.
2. Medication factors: adverse drug reactions, insignificant daily benefit, high daily dose and number of doses.
3. Patient attitude: not perceived need for medication, negative attitude toward medication, perceived significant change in appearance, perceived interference with life goals.