Bipolar disorder, also known as manic-depressive disorder, is a mental disorder characterized by abnormally high or low emotion. Its etiology is still unclear, and it has two main manifestations: manic state and depressive state.
Treatment of bipolar disorder
1. Most patients with episodes require inpatient treatment, and those with severe episodes require mandatory inpatient treatment. Isolate the patient from other people, keep him/her quiet, ensure the amount of food, and pay attention to water and electrolyte balance. Application of antipsychotics olanzapine, quetiapine, clozapine helps to control excitement quickly. Lithium salt has a good therapeutic effect on manic episodes and can prevent relapse, 1 to 2g each time, 2 to 3 times a day for 4 weeks. Haloperidol injection can also quickly control the symptoms of psychosis and mania.
2, sodium valproate or magnesium valproate in lithium salt is ineffective with this drug, 600 ~ 1200 mg per day, but at present often due to side effects of the situation and as the drug of choice.
3, electroconvulsive therapy for severe excitement and agitation, urgent control of the disease is applicable to this method.
4, maintenance treatment for more than 2 repeated episodes, in principle, should be long-term medication. Lithium salt maintenance treatment dose is 2/3 to 1/2 of the original treatment amount. 0.75~1.0g daily.
Psychotherapy
Add psychotherapy to drug therapy. Identify and improve patients’ poor cognitive patterns, emotions and behavioral patterns, provide crisis intervention, and disseminate disease knowledge to patients and families to improve treatment efficacy, enhance social adaptation and improve social function, improve compliance, and reduce relapse.
Treatment course
Establish the concept of long-term treatment and adopt comprehensive treatment.
1.Acute treatment period Control the excitement of the acute phase. Duration of treatment: generally 6-8 weeks.
2.Consolidation treatment period Consolidate the effect of acute treatment and prevent the fluctuation of symptoms. The course of treatment: 2-3 months, the drug dose is generally maintained at the same dose.
3.Maintenance treatment period Prevent relapse and restore social function. Gradually reduce the dose of non-mind stabilizers under careful observation. There is no definite conclusion on how long maintenance treatment should last. The dose and duration of maintenance treatment depends on the patient’s specific situation and varies from person to person, and the treatment plan is individualized. For multiple-onset patients, the drug dose may be reduced while observing and gradually discontinued after stabilization has reached an interval of 2-3 cycles of previous episodes or after 2-3 years of maintenance therapy. If there are signs of relapse during the discontinuation period, the original treatment regimen should be resumed promptly and a longer maintenance treatment period should be given after remission. Early age of onset and positive family history should be treated with maintenance therapy.
Prognosis of disease
Manic episodes are episodic courses with normal remission between episodes, and can be maintained as stable if treated actively. However, if effective treatment and maintenance treatment are not carried out, the relapse rate is high. Long-term recurrent episodes result in increasingly frequent disease attacks, shortened normal intervals, rapid cycling, difficulty in treatment, residual symptoms, chronic state, personality changes, and impairment of social functioning. Therefore, the concept of long-term treatment and comprehensive treatment is needed to prevent recurrence of the disease.
Factors with good prognosis include: good pre-morbid personality, good social adjustment, acute onset, short duration, presence of significant psychosocial stress or somatic disorders before onset, late age of onset, access to early treatment, good treatment outcome, good family and social support system, no history of recurrent episodes, no family history of psychiatric disorders, no comorbid personality disorders, anxiety disorders,, drug dependence, psychoactive substance dependence, and somatic disorders, etc. In contrast, the prognosis is poor.
Disease prevention
Psychosocial factors play an important role in the onset and recurrence of the disease and require attention to psychological regulation.
1, learning about mental health, mastering psychological debugging methods, cultivating an optimistic, positive and healthy personality, improving the ability to adapt to the environment, and maintaining a good state of mind.
2, correction of undesirable behavior patterns, such as impulsive blindness and disregard for consequences.
3, avoid adverse psychosocial factors, avoid long-term high tension, irregular life, often stay up late in life, and properly decompress and relax themselves.
Early detection, early treatment, relapse prevention ：
1, pay attention to the identification of anxiety, depression, anger, boredom and other adverse emotions, pay attention to the identification of the early manifestation of the disease, early detection, early consultation, early treatment of the disease.
2, mania is prone to recurrent attacks, establish the concept of long-term treatment, learn to monitor their mood changes and coping strategies, master the management ability of the disease; regular outpatient review, communicate with doctors, monitor the condition and drug side effects, maintain the stability of the disease and prevent relapse.
3. Avoid recurrent attacks of the disease, resulting in difficult treatment care and functional damage.
Disease care
1, respect, understanding, acceptance, care, support and help patients.
2, correct understanding of the disease, support patients to actively treat, early treatment, recurrent patients to establish the concept of long-term treatment, regular outpatient review, communication with doctors, monitoring the condition and drug side effects, maintaining the stability of the disease and preventing relapse.
3. When the condition is unstable, pay attention to prevent self-injury and suicide, impulsive injury, early consultation and treatment, and good psychological guidance. Avoid conflict and provoke patients when they are in an agitated and severely manic state.
4.Learn disease knowledge and treatment knowledge, help patients observe their condition, respond to changes in their condition in a timely manner, and adopt correct coping strategies to avoid causing harm to themselves and others.
5, pay attention to help patients cultivate a good character, correct poor cognitive and behavioral patterns, learn methods of psychological adjustment, avoid adverse psychosocial factors, and avoid long-term high tension.
Experts suggest not to believe in root removal treatment
1, the etiology of manic episodes is complex, in general, the cause of the onset is not very clear. Therefore, the current level of medical treatment can only symptomatic treatment, can not achieve the root cause treatment that is to eliminate treatment.
2, manic episodes have various seizure forms, and patients can have long intervals of normal performance, not from where the eradication treatment is obtained.
3, in fact, we have many daily diseases such as hypertension, diabetes, etc., are allopathic treatment, not root removal treatment. Do not panic because the disease can not remove the root.
4, chronic diseases, it is understandable to seek treatment, but do not have the disease to terminate the formal treatment.
Correct understanding of psychiatric drugs
Many families and patients believe that psychiatric drugs can make people stupid or will have some serious adverse reactions, and do not accept psychiatric medication, resulting in delayed treatment. In fact, the damage caused by the disease far exceeds that of psychiatric drugs, and regular outpatient treatment, medication adjustment and selection of appropriate drugs can prevent serious adverse reactions from occurring.
Proper understanding of mental illness
1, each of us does not want to get sick, no matter what disease. However, getting a disease is a natural phenomenon, we cannot choose not to get a disease or get any disease, we cannot avoid it.
2, each person in the encounter with a major or serious disease, themselves and their relatives have to go through several psychological stages: surprise, panic, do not know what to do; nervous fear, denial; will believe, around to seek medical treatment; guilt, self-blame and blame, regret and remorse, accompanied by anxiety, depression, low self-esteem, pessimism; fear, fear; finally, the formation of a variety of chronic adaptation, acceptance and face.
3. In fact, all systems of our body can have problems and diseases. Psychological or mental is also the same, is a very important system of our body, the same can also have problems and diseases, is inescapable;.
4, encounter mental illness and psychological problems, there is no need to panic, pessimism, the rapid development of our medical technology, brought about by the rapid development of disease treatment, as long as we actively face, the vast majority of prognosis are quite good, the treatment is neither complicated nor difficult. Even if it is difficult to cure for a while, as long as we do not give up, establish a good therapeutic relationship and therapeutic alliance between patients, families and doctors, deal with the disease together, and systematically accept formal treatment, we will all improve and even achieve a cure.
5. Many of our patients and their families have accumulated many valuable experiences in facing the disease and overcoming it, and have reaped very good results. After recovery, many of our patients work, study and live like normal people.