Mood Disorders, Bipolarity

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Mood disorders, bipolarity

When we talk about affectivity, we talk about two specific aspects that are moods and emotions. The difference between the two is that emotions are situations in which there is a change in the most abrupt mood involuntarily, which are dependent on stimuli and remain in a relatively short period;On the other hand, mood varies between two limits that are sadness and joy, being the persistence of this most durable state with a constant level. In the latter, at the time we transfer the two extremes, it will be when we will be faced with a mood disorder.

Mood disorders are mental health disorders that suppose an alteration of the subject’s emotions, as the name implies. These are also known as affective disorders. Within these we find two groups of disorders:

• Unipolar disorders that are those in which it only suffers depression;and on the other hand,
• Bipolar disorders in which there is presence of depressive episodes and also alternate with mania or hypomania episodes.

Mood disorder is characterized, as well as other disorders, by the appearance of delusional ideas in the subject that suffers it. In addition, the subject is not aware of his ideas and there is also no reasoning, so he has the perception of being right and there is no possibility of contradicting him. This acquires by the pathology that suffers.

Regarding the quantitative disorders of affectivity, we can talk about the following, highlighting:

• Hypotimia: It is smaller than mania. The individual is a low mood with distortion of reality that tends to depression. Taquipsiquia already appears.
• EUTIMIA: It is a normal mood, without showing any symptom.
• Hypertimia: Excess affective level, with extreme and optimistic joy. It occurs frequently after depression.

On the other hand, we also find qualitative disorders of affectivity, among which we can highlight:

• Euphoria: It gives rise to exaggerated joy, entering a level of hypertimia. This has different degrees: joy, euphoria, pathological euphoria (there is some fiction where the person does not know howFind the exaltation of mood, hyperactivity, high self – esteem, increased physical activity, among many other changes).
• Depression: It is characterized by sadness, inhibition, and in some cases there would be Bradipsiquia (slowdown of thought) and also a motor inhibition. Depression has a 4% prevalence in men and 8% in women, with an incidence rate between 4 and 8 people of every thousand those who suffer per year. Single or divorced people, those who have a low socioeconomic level, those who have suffered recent stressful events and those who lack social support, are the most likely to fall into depression. Inside this we are:

1.  Dystimia: neurotic depression. It is the first pathological degree of this, being continuous and long term. This is the slightest form of depressive disorders · 
2. Melancholy: It is a deep degree of depression. Sadness and memories of newspapers of happiness. Produces a personality and reality alteration.

• Angustia/Anxiety: It appears when there is a feeling of lack of conformity or discontent in a person, with vegetative reactions. In short, anxiety can create two types of fear: fearless fear, where the idea does not focus on any object, so the obsessive idea is manifested;And on the other hand, fear with an object, where fear is deposited on an object, giving rise to phobias (irrational anguish). Angustia is characterized by having a psychophysiological correlate, which are all vegetative responses such as sweating, dry mouth, dizziness, etc.
• Indifference: State in which you neither affect you or react to external stimuli, whether positive or negative.
• Ambivalence: ability to experience two emotions or opposite feelings.
• Discordant affection: It is an affective reaction contrary to that normally determined by stimuli.

Focusing on bipolar disorder, also known as depressive maniac disorder, is characterized by the alternation of mania episodes (high mood, euphoric) or hypomania with other episodes of low mood and hopeless mood, that is, depressions, soWe conclude that this disorder has a dual pathology. These states may appear separately, but mixed episodes can also. This has a cyclic course and its prognosis is deteriorated if it suffers more and more relapses and if they are more intense. The treatment that is diagnosed to patients helps to limit the intensity and repetition of maniac episodes, although it can become chronic for some patients, approximately between 10-20%.

Bipolar disorder has a 1% prevalence with respect to the entire population. In addition, there are no differences between the sexes, it equally affects both men and women. The age of appearance of the disease is between 20 and 30 years, but there may be exceptions being developed during childhood, adolescence or even 40-50 years.

One of the risk factors with which there is the most possibilities to develop the disease is to be the son of a patient with bipolar disorder, finding us between 15% and 30%, but the possibility between 50% and 75% is raised ifBoth parents have a history or are affected. If the parents presented the first episodes of the disorder before the age of majority or have another psychiatric disorder, it also makes the risk of inheriting it. In the case of having a brother with the disorder, it represents a risk of between 15% and 25%, but if this is a twin brother identical the possibility increases to 70%. For these factors, we can say that this disorder is hereditary. Finally, drug dependence can also cause the beginning of characteristic episodes of this disorder.

In spite of this, the cause for which the disorder is developed is unknown, it is thought that it can be a brain alteration that results in an irregular functioning of some of its functions. In addition, it is believed that it is a consequence of the mixture of psychological, genetic and biochemical factors.

As for the clinical symptoms of bipolar disorders, we find several types depending on the way in which the manic and depressive phases are alternated and evolved:

• Type I: The subject must have suffered at least one maniac, hypomania or mixed episode. Approximately 1% of the adult population presents symptoms that meet the criteria of this type of bipolar disorder.
• Type II: The subject has had at least a major depressive episode, accompanied by at least an at least maniac episode. He never had a manic episode or any mixed episode. This type of disorder also suffers from approximately 1% of the population.
• Cyclothymic disorder: The subject has suffered for at least two years many periods with hypomaniac symptoms and episodes with depressive symptoms, without becoming a major depressive episode. Throughout these two years, he could not be more than two months without having suffered any symptoms. In addition, no manic, mixed, or major depressive episode has been given as I said, during these two years, thus being the slightest form of bipolar disorder. The symptomatology of this is suffered by 1% of the population, as the previous two.
• Bipolar disorder not specified: the subject presents some type of symptom characteristic of bipolarity, but these do not follow the criteria of the diagnostic and statistical manual of mental-IV disorders so that none of the previous types can be diagnosed. In this case the population that can suffer from symptoms of this type is between 2-5%.

Regarding the symptoms of bipolar disorder, they are very disparate depending on the phase in which they occur. It should be noted that patients can be found in a remission phase, in which these have been long periods of time without suffering any symptoms. The symptoms can last weeks and even months in some cases, these are:

Mania or manic phases

This takes place at the moment when the patient is in the Maniaca phase, where the possibility of appreciation of ideas can occur. At that moment, the person loses the ability to organize what he thinks;His thinking is altered that can occur with or without verbiage (speech acceleration being this incomprehensible) so it is difficult to have a conversation with him;He has the ability to change the subject suddenly without them having anything to do with each other and can even associate words for their assonance;And being in an altered mood without reason of being and with great confidence in itself, could carry out acts that in other situations would not, acting in an contrary to their thoughts and feelings, acts of which it will regret andIt will oppose the idea of having done them, that is, impulsivity predominates about it.

One of the first manifestations is the lack of the need for sleep. Despite this, this is in an energy state, with a great sense of well -being and optimistic. This can affect your way of thinking and judging, or you can produce beliefs other than reality, that is, hallucinations or delusions. At the moment in which the opposite is taken, it can become irritable and hostile.

The Maniaca phase can affect, carrying negative consequences, both its person and their work, social and family environment. In summary, the person suffering from mania can notice emotional changes, in thought, physical or in behavior.

In this phase, admission is once necessary. But instead, other times, simply with pharmacological treatment, symptoms can be reduced to disappear, thus allowing the recovery of the patient’s personality.

Hypomania or hypomaniac phases

This is not as serious as mania, since it has the same symptoms but they are less intense and tragic. These symptoms can allow the patient to lead a working, social and family life normally, and find themselves in a state of intense well -being and with great imagination and self – esteem where they carry out a series of ideas or thoughts of which you can regret it. However, it is not surprising that the consumption of alcohol and that of other substances increase in the subjects that suffer from it.

Due to her, no changes in behavior so serious that forces hospitalization are manifested. Although it is true, that it can get worse and end up becoming a mania or ending up developing a depression, so it is of great importance to treat it in time to avoid these changes and that the suffering of the patient is not so strong.

Depression or depressive phases

Depression is probably the most frequent manifestation of this disorder. Due to this, patients are sad, frustrated, with a loss of yearning and interest in the people or things that cared, with alterations in sleep and appetite, with a loss of sexual desire and a constant feeling of tiredness whereEverything is a great effort. In addition, they begin to have very negative thoughts, thus becoming a pessimistic, "failed" person and with a very low self – esteem. All this, can lead him to have thoughts related to death and can even try to commit suicide, this being an exit to stop suffering and not suppose a burden for those around him.

All these symptoms are very difficult to distinguish with those of normal depression. Therefore, many of the patients suffering from bipolar disorder are not correctly diagnosed as such until the moment they have episodes of great elevation of humor or have episodes similar to those who had previously suffered. Given this situation, some patients who have already had episodes previously face it as well as possible since they know it is temporary and will leave it, but others think that no treatment will make it possible to overcome it and that their life makes no sense.

In relation to the diagnosis of bipolar disorder, there is no research or trial that can lead us directly, so several years have elapsed since the symptoms appear until the exact diagnosis occurs.

This is carried out with the data provided by relatives and the patient’s medical history. At the time when the first symptoms have been suffered a manic, hypomaniac or mixed episode, bipolar disorder is diagnosed. On the other hand, these symptoms cannot coincide with those of other psychiatric diseases or with the consumption of narcotics. All these criteria are established in the DSM-IV Manual (Diagnostic and Statistical Manual of Mental Disorders).

About treatment, their objective is to prevent patients from having manic or hypomaniac phases and depressive phases, so that they can lead a life as normal as possible. Despite this, they can suffer from relapses but it is less frequent if they carry their treatment up to date and maintain regular and healthy habits. This disorder can be treated in two different ways: on the one hand, it can be treated with pharmacological treatment, which can vary depending on the phase in which the patient is. We find:

• Eutimizing drugs: which are the most important. This is key to treating the phases of depression, hypomania and mania, and to prevent them from having relapses again. For these to be effective, they must be taken prolonged and continuously. The most used is lithium, with which periodic blood tests are necessary since it is quite it and can be harmful according to the dose taken.
• Antiepileptic drugs: to try to avoid or prevent relapses of both manic and depressive episodes.
• Antidepressants: They try to deal with the depressive phases of the disorder. For these to be effective, they must be taken for several weeks and combine them with some eutimizing drug because their use can produce the development of a maniac phase.
• Antipsychotic drugs: they are more used in the Maniaca phase and like antidepressants, they are usually combined with eutimizing drugs. They help stabilize disorder.

All of them are important to try to prevent symptoms, but unfortunately a large number of people decide to stop taking them, which leads them to suffer from relapses. On the other hand, we find psychotherapy and psychosocial treatments, since it is of great importance for the patient to have a relationship of trust with professionals that can help him in his disorder. In these meetings the objective is that both patients and family members are aware of the disease, their treatment and their position to face it. Therefore, family intervention is essential since they live with them and must support it. In addition, they can be helpful to prevent relapses and give stability if the patient is not aware that he is getting worse.

As a last resort, electroconvulsive therapy can be performed, which consists of small electric currents through the brain that causes changes in cerebral neurochemistry so that they can impact the symptoms of the disorder. This is performed at the hospital and always under anesthesia.

In general there is no way to prevent bipolar disorder, but it is of great importance that patients follow some type of treatment such as the previous ones, do not consume alcohol or drugs, follow the guidelines given by the psychiatrist who carries it, learn to detectThe symptoms that lead him to relapse and have regular sleep schedules so that his disorder can improve. In the other way, those who are not treated or decide to leave their treatment will have a safe relap.

On the other hand, bipolar disorder in children and adolescents is less frequent and occurs gradually. In addition, this disorder can lead to other problems at the same time, such as: abusing substances such as alcohol and drugs, attention deficit disorder with hyperactivity by making it difficult to concentration and anxiety disorders. The fact that children or adolescents have been mistreated also has an important relevance that can make them present this disorder. Young people can run many more risks than adults, so it is important to treat it as soon as possible.

Finally, in the future, it is expected to ensure that society has no rejection of people who suffer from it, especially in the workplace. In addition, it is intended to learn more about the causes that give rise to emotional alienation and have more knowledge about the biological basis of the disorder and how it affects brain functions. It is also estimated that the treatments are more effective and with less side effects.