Bipolar Disorder: Symptoms and Therapy

Bipolar disorder (also named manic-depressive disorder) is characterized by sudden and unpredictable changes in the tone of mood, energy, and activity levels. During the disturbance, alternation between depressive and manic episodes may occur, or there may be only manic episodes (in these cases a type 1 bipolar disorder can be diagnosed). The alternation between depressive and hypomanic episodes, on the other hand, allows to diagnose a type 2 bipolar disorder. The symptoms of the disease may be severe.

The symptoms of the depressive phase may remind partially those of Major Depression with some differences: predominant presence of hypersomnia, hyperphagia and heaviness in the lower limbs.

Among the symptoms of the manic or hypomanic phase can be mentioned: euphoria, grandiosity, hyperactivity, logorrhea, flight of ideas, decreased need for sleep, excessive spending, excessive involvement in playful or dangerous activities. During the manic phase people refer periods of insomnia (which could last for weeks too) or difficulty resisting the impulse to carry out over or overwhelmed expenses. In the stages of excitement, the subject may also become abusive of narcotic drugs or alcohol.

The mood swings of the bipolar disorder are different from the normal and physiological ones and in the manic phase they may lead to a reduction in social relationships, working and even attempted suicide and/or psychotic manifestations (with the need for psychiatric hospitalization). The age of onset of the disorder is between 18 and 22 years. The prevalence of pathology throughout life in Italy is 1.2-1.6%.

Recent studies have demonstrated the existence of a genetic difference between the two subtypes of bipolar disorder: this discovery could facilitate the identification of specific innovative drugs (Charney et al., 2017).

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In addition to symptomatic remission, the priorities for a successful treatment of the disorder remain the recovery of full-time working-life and the restoration of the quality of life.

Numerous studies have found that mood stabilizing drugs (lithium, lamotrigine, valproic acid, carbamazepine) can lead to symptom remission and significant improvements in work function with benefit on quality of life (Gonda et al., 2016 ).

Antipsychotic drugs can also be used to enhance the effect of mood tone stabilizers.

A new drug that has been shown to be effective in treating bipolar disorder is lurasidone: an atypical antipsychotic that acts with an indirect effect on the disease (ie through the improvement of depressive symptoms). Lurasidone, either in monotherapy or in combination with lithium or valproic acid, would therefore seem to be a useful drug for treating bipolar depression (Rajagopalan et al., 2016).

Psychological interventions on patients with bipolar disorder generally produce variable results and modest effects. The development of a new cognitive-behavioral therapy based on an integrated cognitive model (focused on mood swings oscillations) could help patients improving the outcome of pharmacological treatment (Joyce et al., 2016).

References:

Charney AW et al (2017). Evidence for genetic heterogeneity between clinical subtypes of bipolar disorder. Transl Psychiatry. 7(1): e993.

Gonda X et al (2016). [Changes in quality of life and work function during phase prophylactic lamotrigine treatment in bipolar patients: 6 month, prospective, observational study].Neuropsychopharmacol Hung. 18(1): 57-67.

Joyce E et al (2016). What are People’s Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. Clin Psychol Psychother.

Rajagopalan K et al (2016). Effects on health-related quality of life in patients treated with lurasidone for bipolar depression: results from two placebo controlled bipolar depression trials. BMC Psychiatry. 16: 157.

Tiziana Corteccioni

About Tiziana Corteccioni

Tiziana Corteccioni

MD, Specialist in Psychiatry, Psychotherapist, Cognitive behavioral therapist.

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