Bipolar disorder is a mental condition formerly known as manic depression. This psychiatric illness causes mood disruption with alternating phases of depression and excitement (manic episodes).
“To depress”, etymologically, means “to belittle”. Depression is the lowering of mood.
An episode of depression is characterized mainly by a great sadness of the mood, a loss of vitality and a psychic and motor slowing down for a duration of at least 15 days.
Symptoms needed to diagnose BIPOLAR DISORDER are:
The mental state is markedly altered from usual functioning, accompanied by significant suffering and discomfort in daily life.
The mood is sad and depressive (“cockroach”, demoralization, moral pain …).
There is a loss of interest and pleasure (anhedonia) in usual activities.
We often observe a significant slowdown resulting in great slowness, a sign of lack of energy and drive, which makes daily tasks insurmountable. Sometimes, on the contrary, anxiety leads to feverish agitation and the inability to sit still.
Intellectually, concentration and memory impairment are observed, with patients complaining of not being able to find their words, and great fatigability for minimal efforts such as reading or carrying on a conversation.
Very frequent are pejorative ideas about yourself: self-criticism and self-accusation, fueling great guilt vis-à-vis those around you that you feel unworthy.
Suicidal ideation is common.
Body and mind unite in pain: sleep and appetite are disturbed while libido collapses …
Other symptoms may be present in some patients:
more or less intense and permanent anxiety often present upon awakening, and diminishing during the day, especially in the evening,
so-called “functional” symptoms: headaches, diffuse or localized pain, digestive disorders,
character disorders: irritability, aggressiveness, temper tantrums, heightened susceptibility, hypersensitivity to rejection
withdrawal into oneself, avoidance of others and contact,
alcohol pipes or other toxic substances.
Without any treatment, the course of a depressive episode is variable, but spontaneous improvement in bipolar disorder typically occurs in 6 to 9 months.
Melancholy is a special form of depression characterized by the intensity of sadness and emotional pain in the patient who experiences permanent discomfort. The patient feels unworthy of life, refuses to eat. Sometimes melancholy is accompanied by delusional signs with ideas of guilt, ruin, incurability (“it will never get better”) to hallucinations which make the patient hear voices insulting him, covering him with pain. Insanities or that makes him breathe unpleasant odors.
Suicidal ideation, which is often concealed and determined, is common, sometimes with serious acts.
Melancholy is a therapeutic emergency requiring appropriate care in a protected environment.
At most we observe a stuporous form of melancholy: catatonic syndrome, the patient then freezing like a statue. Emergency seismotherapy treatment is then indicated as a first-line treatment.
In Greek “mania” is synonymous with “madness”. In French, in the everyday language, mania emphasizes excess: music lover who loves music to excess, maniac who fixes on details …
In the psychiatric sense, manic access is characterized by a state of psychic and motor arousal with elation of mood and megalomania.
Manic attack comes on suddenly but may be preceded by a phase of moderate intensity called “hypomania”.
Factors favoring the outbreak of such access are not always identified. While stressful elements such as emotional shocks, affective conflicts, somatic ailments or bereavement are sometimes found in the days or weeks preceding its onset, these elements may in fact be seen as mere catalysts in people. Individuals already showing some vulnerability.
Typically the first symptom is insomnia, a decrease in the need for sleep without fatigue.
The mood is quickly changing, a playful, expansive and euphoric joviality alternates with moments of irritability where the patient appears to be angry or may burst into tears. He is said to go from laughter to tears, a sign of emotional lability.
Psychic arousal results in an acceleration of thought (tachypsychia), the flow of words (logorrhea). Ideas come together, projects are multiple, grandiose and unsuitable, rarely completed. The speech goes from rooster to donkey.
Contact with others is easy and familiar, resulting in great communicability and an amazing ability to detect and react to the attitudes of others (hypersyntonia).
Disinhibited, the patient sings in the middle of his sentences, makes caustic, daring jokes, easy puns, puns.
Motor restlessness is marked, the patient cannot keep still, gets up suddenly, walks. Hyperactivity is sterile, disorderly.
The outfit is scruffy, fanciful, sometimes extravagant. The face is hyper-expressive, endlessly agitated with movements, imbued with theatralism.
Typical manic attacks always involve a certain megalomania, with ideas of grandeur and overestimation by the subject of his own capacities and importance, in particular at the origin of grandiose projects.
The body experiences this state of intense excitement: the insomnia is almost total, without the patient feeling the slightest fatigue; hunger and thirst are often intense, without weight gain. Sometimes, on the contrary, due to lack of time or lack of interest the subject no longer feeds, leading to weight loss or even dehydration …
Euphoria and disinhibition lead the subject to engage in risky activities out of playfulness, or by ignorance of the danger: disorderly and risky sexual behavior, driving at full speed, unforeseen travel, reckless expenses, agitation on the public highway .
In delusional mania megalomania reaches the level of delusional conviction, no reasoning or argument can shake it. The patient experiences feelings of grandeur, omnipotence or a mission to accomplish, erotic themes are frequent, as well as prophetic intuitions.
Not to be confused with depression
Certain states of mental suffering can evoke depression without constituting a depressive state in the medical sense of the term.
Thus can evoke a depressive syndrome:
A normal, isolated, unsustainable state of sadness, adapted in reaction to a painful, unpleasant, threatening or frustration context, for example following bereavement.
Some medical conditions that can cause depressive symptoms: certain neurological diseases such as dementia, Parkinson’s disease, epilepsy, stroke, certain hormonal diseases, foremost among which hypothyroidism, but also certain diseases of the adrenal glands.
certain infectious diseases such as influenza, hepatitis, infectious mononucleosis …
Alcohol dependence, drug addiction and the abuse of certain drugs. They can cause a depressive-looking syndrome which regresses during withdrawal. But keep in mind that these forms of drug or drug dependence are also very often concomitant with depression and bipolar disorder (see “co-morbidities”).
Certain other psychiatric illnesses:
severe anxiety disorders, which can involve withdrawal, insomnia (rather falling asleep) and demoralization linked to the disability and the chronicity of the disorder,
psychotic disorders, especially schizophrenic disorders.
Not to be confused with mania
Many conditions can be associated with a state of excitement:
drug poisoning (corticosteroids) or drug addiction (alcohol, cocaine, hashish, hallucinogenic products)
organic brain conditions such as certain brain tumors or epilepsy
hyperthyroidism or other hormonal diseases
other psychiatric conditions which may involve significant psychic and motor arousal but in which playful behaviors and euphoria are often more subdued than in typical mania: certain forms of schizophrenia, the sharp delusional puff,
certain manifestations encountered in personality disorders, in particular of the hysterical type.
In the aftermath of bereavement some people will develop a psychomotor arousal called bereavement mania which can reach pathological intensity.
Mania and depression, a bit of history
We find the first traces of mania and depression in the 5th century BC at the time of Hippocrates, the first to establish a description that has come down to us: the transformation of melancholy (from the Greek “melas kholé “Or black bile) in madness (” mania “in Greek).
It was only in 1854 that two French psychiatrists, Falret and Baillarger, independently of each other, brought together these two states in the same disease: “circular madness” for the first, “double form madness” for the second.
It was not until 1899 that a German doctor, Kraepelin, described the modern and current conception of manic-depressive illness (or “manic-depressive illness”), the name of which will be truly stated for the first time in 1907 by Deny and Camus. .
In the 1960s, a distinction was made between bipolar disease and unipolar disease in which only depressive episodes occurred.
Over the past two decades, research has multiplied leading to new international classifications, notably the “International Classification of Diseases” (CIM or ICD) and the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) in the United States. , and new names (bipolar I, II, III). One of the most widely used classifications is the DSM IV which appears in the appendix.
Epidemiology of bipolar disorder: some figures
Bipolar disorder begins most often in early adulthood, on average between 18 and 24 years old, but it can sometimes occur in childhood or, conversely, much later in life.
Worldwide, the prevalence of bipolar disorder type I is estimated to be 0.6%, that of type II is 0.4%, and that of subthreshold bipolar disorder is 1.4%, yielding a total bipolar disorder spectrum prevalence of 2.4%, according to a new report in the March issue of the Archives of General Psychiatry. By including types II or III we get significantly higher figures, up to 5 or even 7% of the population including the entire bipolar “spectrum”, that is to say all related disorders.
Men and women are affected in equal proportions.
Bipolar disorder is more common in urban areas without the socioeconomic level explaining this difference.
There are no ethnic differences in distribution, however it is recognized that cross-cultural aspects may tint episodes in different ways. These aspects must be taken into account in the diagnostic and psychotherapeutic approach.
60% of bipolar people are affected by substance abuse, especially alcohol.
Epidemiology Figures Nature of Bipolar Disorder Bipolar Disorder
Like many psychiatric illnesses, bipolar disorder comes in different forms and to varying degrees. In the absence of treatment, the spontaneous frequency and duration of manic or depressive attacks vary widely. The “normothymic” periods can last several years, sometimes bipolar disease can be reduced to a single episode during the life, without recurrence.
The risk of death by suicide is 10 to 15% for type I bipolar patients and 15 to 20% for all forms, this risk being greatly reduced by appropriate management.
Bipolar disorder ranks 6th among disability-causing diseases in terms of social and economic cost.
Bipolar disorder and creation
“You don’t have to have a mood disorder to do a job of genius, and most people with manic depression aren’t particularly over the top. But the fact is that creatively gifted individuals are more often affected by this type of affection than the average person. “
This statement by psychiatrist Kay R. Jamison should not hide a medical truth: bipolar disorder is a severe illness with painful and sometimes dramatic personal, family and social consequences.
It is a source of suffering, and not of creation, for the patient and for those around him. If some artists are or have been suffering from bipolar disorder, it is in spite of it and not thanks to it that they have been able to transmit their work to us.