Tough Love

When I was writing my blog post on Monday I also came across a heart string pulling article regarding a husband's decision to have his wife sectioned because of her struggle with Bipolar Disorder;

http://news.bbc.co.uk/1/hi/health/8511478.stm

Bipolar disorder (also known as Manic-Depressive Disorder, or Bipolar Affective Disorder) is clinically classified as a mood disorder and characterised by a mixture of abnormally elevated moods, referred to as Mania (which may also lead to delusions and hallucinations), and depressive episodes, of which the sufferer will see as "normal". Dependant on the individual these may alternate (rapid cycling) or they may be separated by spates of "normal" moods. According to Mind approximately 1-2% of the general population is diagnosed with Bipolar; there is no statistical difference between male and female numbers, and it usually affects those in their 20s-30s.

This disorder has been separated into subcategories and thus Bipolar is also classified as a spectrum disorder; Bipolar I, Bipolar II, Cyclothymia, or Mixed States. The diagnosis is dependant upon the mania, hypomania and depressive episodes experienced by the sufferer. Angst, J., et al (1978) created a system by which to classify a person within the spectrum;
M : Severe Mania
D : Severe Depression (unipolar depression)
m : Less Severe Mania (hypomania)
d : Less Severe Depression
Therefore, MD would mean the person experiences severe mania followed by severe depression, mD less severe mania (hypomania) followed by severe depression (unipolar depression), etc.

According to the NHS the symptoms of Bipolar disorder are thus;
Mania;
The manic (high) phase of bipolar disorder usually follows 2-4 periods of depression and may include:
feeling very happy, elated, or euphoric (overjoyed),
talking very quickly,
feeling full of energy,
feeling full of self-importance,
feeling full of ‘great’ new ideas and having ‘important’ plans,
being easily distracted,
being easily irritated, or agitated,
being delusional, having hallucinations, and disturbed, or illogical thinking,
not feeling like sleeping,
not eating, and
doing pleasurable things which often have disastrous consequences, such as spending large sums of money on expensive and, sometimes, unaffordable, items.

Depressive Episode;
During a period of depression (low phase) your symptoms may include:
feeling sad and hopeless,
lacking in energy,
difficulty concentrating and remembering things,
a loss of interest in everyday activities,
feelings of emptiness or worthlessness,
feelings of guilt and despair,
feeling pessimistic about everything,
self-doubt,
being delusional, having hallucinations, and disturbed, or illogical thinking,
lack of appetite,
difficulty sleeping and waking up early, and
suicidal thoughts.

There is no definite answer to what causes this disorder; life events, genetics, sleep disturbance and problems with the endocrine system have all been suggested as being possible factors. As with many psychiatric disorders, much more research is required (which I hope to be part of one day!).

Treatment of Bipolar Disorder can take various forms (it depends on what the psychiatrist in charge of the case feels is best), there is no cure as of yet so treatment is symptomatic/management based. Medication wise the drug of choice for rapid cycling Bipolar Disorder more often than not are mood stabilisers such as Lithium; Lithium Carbonate or Lithium Citrate, or Carbamazepine, Semisodium Valproate or Lamotrigine (these three are also anti-convulsants). These are used as long term treatment. Some antipsychotic drugs such as Olanzapine, Quetiapine, Aripiprazole, Haloperidol, Chlorpromazine and Risperidone are also used as treatment of manic episodes. These can be taken at the same time as the mood stabilisers, but are usually short term. To aid in the prevention of relapse a number of Psychotherapeutic/"talking" therapies may be undertaken with the assistance of a psychologist; the most favourable being Cognitive Behavioural Therapy (CBT), this can basically challenge negative thoughts, feelings and behaviours and aid in creating a positive interpretation of them. Hospital Admission is an extreme treatment, but for those incredibly distressed it may be the only "safe" option, it is something they can seek out themselves, or may be compulsory due to sectioning under the Mental Health Act 1983.

The article is an incredibly interesting read, and even gives the option of listening to it on iplayer.It gives a unique insight to how such a disorder affects a relationship, and how diagnoses have changed in recent years. "Fresh air" is no longer classed as appropriate treatment for mental health disorder!