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What Triggers Bipolar Disorder?

What is bipolar disorder?

Bipolar disorder is a mental condition that causes unusual and extreme shifts in mood. Bipolar disorder is characterized by periods of deep, prolonged and profound depression that alternate with periods of an excessively elevated or irritable mood known as mania. Bipolar disorder is also called manic-depressive illness or manic depression.

Bipolar disorder does not have any cure, but with appropriate medical treatment and psychological support, its symptoms can be controlled.

What triggers bipolar disorder?

  • Genetic factors
    • First-degree relatives of people with bipolar disorder are approximately seven times more at risk.
  • Biochemical factors
    • Depletion of certain chemicals in the nerve endings may cause bipolar disorder. This can occur due to hormonal imbalance from certain medication or drug abuse, such as cocaine.
  • Neurophysiologic factors
    • Changes in the gray and white matter in the brain can lead to bipolar disorder.
  • Psychodynamic factors
    • Depression is the manifestation of losses (for example, loss of self-esteem and the sense of worthlessness). Mania can occur as a defense mechanism against depression.
  • Environmental factors
    • Stressors such as:
  • Pharmacological factors
    • Antidepressant medications can sometimes trigger a patient into a manic episode.

What are the signs and symptoms of bipolar disorder?

  • Manic episodes:
    • Characterized by at least one week of severe mood disturbance with elation, irritability or expansiveness. At least three of the following symptoms must also be present:
      • Grandiosity
      • Diminished need for sleep
      • Excessive talking or pressured speech
      • Racing thoughts or flight of ideas
      • Clear evidence of distractibility
      • Increased level of goal-focused activities — at home, at work, or sexually
      • Excessive pleasurable activities, often with painful consequences
  • Hypomanic episodes:
    • This is not as severe as manic episodes.
    • It is characterized by an elevated, expansive or irritable mood for at least four consecutive days.
    • At least three of the symptoms of manic episodes must be present.
  • Major depressive episodes:
    • They are characterized by the person experiencing five or more of the following symptoms for at least two weeks and at least one of the symptoms must be a depressed mood or loss of pleasure or interest:
    • Depressed mood
    • Markedly diminished pleasure or interest in nearly all activities
    • Significant weight loss or gain, or significant loss or increase in appetite
    • Inability to fall asleep (insomnia) or excessive sleep (hypersomnia)
    • Agitation
    • Decreased control of body movements
    • Fatigue
    • Feelings of worthlessness
    • Excessive guilt
    • Inability to focus or marked indecisiveness
    • Thoughts of death, suicide or suicide attempts

What are special signs of bipolar disorder in women?

Hormonal changes during the menstrual cycle, pregnancy or menopause can trigger bipolar disorder in women. Nevertheless, the signs and symptoms of bipolar disorder are not sex specific — women present the same way as men.

What are the different types of bipolar disorder?

There are three main types of bipolar disorder: Bipolar I, bipolar II and cyclothymic disorder.

  • Bipolar I disorder
    • Bipolar I diagnosis involves at least one manic or mixed episode, lasting at least one week or an episode that causes hospitalization.
  • Bipolar II disorder
    • Involves a current or past major depressive episode lasting for at least two weeks. The person must also have had a current or past episode of hypomania. Women have a higher risk of developing bipolar II disorder than men. 
  • Cyclothymic disorder 
    • Patients may experience ongoing bipolar symptoms that don’t meet the full criteria for a bipolar I or bipolar II disorder. It is a less severe form of bipolar disorder. There are frequent episodes of hypomanic and depressive symptoms, but they are not as severe. Symptoms generally persist for around two years.

How is bipolar disorder diagnosed?

  • Clinical and psychological assessment by the physician
  • Mood charting
  • Blood investigations to rule out biochemical causes
  • Radiological investigations (CT, MRI, functional MRI)

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How is bipolar disorder treated?

Does bipolar disorder require hospitalization?

Patients with severe symptoms may require hospitalization. Some indications for hospitalization are:

  • Danger to self
  • Danger to others
  • Delirium
  • Psychosis
  • Total inability to function
  • Total loss of control (e.g., excessive spending or going on dangerous trips)
  • Medical conditions that require monitoring (e.g., substance withdrawal/intoxication)

What is the prognosis of bipolar disorder?

Bipolar disorder has a high morbidity and mortality rate. There is significant impact on the quality of life. It affects the ability to work, interact and maintain relationships. It can lead to substance abuse and harm to others and/or self. Bipolar disorder cannot be cured completely but with appropriate medical treatment and psychological support, the symptoms can be controlled, greatly improving patients’ lives.

Factors that worsen the prognosis include:

  • Poor job history
  • Substance abuse
  • Psychotic features
  • Depressive features between periods of mania and depression
  • Evidence of depression
  • Male sex
  • Pattern of depression-mania-normal state
  • Thoughts of death and suicide
  • Suicide attempts

Factors that improve the prognosis include:

  • Length of manic phases (short duration)
  • Late age of onset
  • Fewer thoughts of suicide
  • Fewer psychotic symptoms
  • Fewer underlying medical problems

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