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Health and
Fitness
Bipolar Disorder
Arjun, a college fresher was taken to be the happiest boy on earth by his
friends during the first week of college. He dressed well, cracked jokes
and during every off period he strummed his guitar making his own lyrics.
Many girls fell for him right away and he found that very flattering. Some
of his friends were however quite surprised when he said that he was
thinking of contacting Sting and was sure that he would win the Grammy
Award in near future.
Two weeks later Arjun won the second prize in the music competition of his
college. On hearing the results he smashed his guitar and tore all the
lyrics he had made. He started calling the judges bad names and said that
they had lobbied the results or he would have surely secured the first
position. He started to come to college unshaven, his hair would be in a
mess and he smoked whenever he could. When he was asked by a professor to
leave the class due to inattentiveness, he tried to throw himself of the
balcony.
Luckily Arjun was saved. He was taken to the psychiatrist and is now
undergoing treatment for bipolar disorder.
 Bipolar Disorder, also known as manic depressive psychosis is a serious
mental disorder characterized by cyclic mood swings, the patient
oscillates between extreme sadness and happiness. During a manic phase
there is hyper-excitability, extreme elation, excessive motor activity,
boundless energy, rapid flight of ideas, inflated self esteem, lack of
need of sleep, engaging in hazardous activities, talkativeness, increased
sexual drive, pursuing goal directed objectives. During a depressive phase
a person feels deep despair, retardation of ideas, hopelessness, lack of
self confidence, uncalled for guilt, decreased sex drive, under activity,
unresponsiveness, poor professional / academic performance, fatigue,
difficulty in concentrating and decision making, restlessness,
irritability, over sleeping, loss of interest in pleasurable activities,
change in appetite (sudden weight loss or weight gain) and sometimes
suicidal impulses. Statistics show that one out of five people suffering
from bipolar disorder take their lives.
A manic episode is diagnosed if elevated mood occurs with three or more
symptoms daily, almost every day, for one week or longer. A depressive
phase is diagnosed if at least five symptoms last most of the day, nearly
every day, for a two week phase or longer. When the mania is mild or
moderate it may be termed as hypomania.
It is a popular misconception that the manic phases are less harmful than
the depressive phases. Though manic phases may be characterized by
elation; it is often accompanied by irritability, over spending, poor
judgement, substance abuse, unrealistic belief in one’s abilities,
provocative and obnoxious behavior. When a person is on a manic high he
may just deny that there is a problem with him and wish that the euphoric
stage persists. Interestingly many bipolar patients have had to be
hospitalized during manic phases. Psychiatrist, Dr. Satyajit Ash says,”
Though a person may feel happy, hopeful and look towards a brighter future
during a manic high, the condition definitely needs medical attention as
they behave irrationally and lose their sense of judgement. If their
wishes are opposed during a manic phase they often tend to get violent.”
The diagnosis of Bipolar Disorder may often may often be confused with
schizophrenia because bipolar patients often suffer from typical psychotic
features of schizophrenia like paranoid ideation, delusions and
hallucinations. Indeed, neuro-imaging studies suggest neuro-developmental
similarities between schizophrenia and bipolar disorder. Anxiety disorders
specifically post traumatic stress disorder and obsessive compulsive
disorder are very common in bipolar patients. Many of them in fact become
alcoholics and drug addicts.
Doctors are yet to find a definite cause for bipolar disorder. It may be
caused due to an imbalance in certain chemical messengers in the brain
called neurotransmitters. Bipolar disorder is often seen to be running in
families proving that it does have a strong genetic component. If one twin
is bipolar there is 50 % chance that the other identical twin will suffer
from the same ailment. Too much or too little thyroid hormone can lead
also to mood swings.
The onset of bipolar disorder is usually during the late teens or early
twenties. Some however have symptoms as a child too. By definition,
bipolar disorder is recurrent. Research shows that 90 % of people who have
a manic episode go on to have future ones. On an average a person has four
episodes in ten years. When more than four episodes occur within a year,
then the ailment is a rapid cycling one. Bipolar patients have poor peer
relationships, marital break ups and often lose their jobs.
Sabita Maiti, Case Coordinator of Paripurnata, a halfway home in Kolkata
shares a case of bipolar disorder they treated, ”Teena had her first
depressive episode when she was in Class XII. She dressed in dirty rags,
wandered aimlessly in the streets, scavenging garbage for food. The people
of her community admitted her to Pavlov Mental Hospital and was later
brought to Paripurnata. Mood swings were quite recurrent in her. Sometimes
she would be cheerful, laughing, telling everyone she had so many
qualities and wanting to draw attention. Other times she would be in
tears, thinking her life was hopeless, that nobody loved her and thought
her to be a victim of circumstances of her bitter past. But she was
treated for her illness and is now back at home and well.”
Like every other mental ailment, bipolar disorder is treated through
medication and counseling. A patient must approach the doctor early
otherwise it may become a life time ailment making suicide a likely
consequence. Medications known as mood stabilizers are usually prescribed
to control bipolar disorder. For 80 % of bipolar patients, lithium
effectively controls symptoms. Anticonvulsant medications may be used
along with lithium. Anti-depressants are not always recommendable because
though they may alleviate depression they may trigger a manic high in the
process. Anti psychotics are often effective during the manic stage. If
mood swings are triggered by thyroid problems, thyroid pills are to be
taken in addition to the usual medication.
Cognitive behavioral therapy helps bipolar patients to change harmful
thought patterns and behaviors. Family therapy helps to reduce distresses
within the family. Interpersonal and social therapy helps to solve
relationship problems and better social skills.
–
Pallavi Bhattacharya
August 29, 2004
* The names of the mentally ill patients have been changed for sake of
privacy.
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