Demystifying Bipolar Disorder
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Dr Milan Balakrishnan, Psychiatrist & Psychotherapist throws light on a subject that even care givers in a family don't know much about. Bipolar Disorder is a serious Mental Illness which affects 60 Million in the world including over 9 million in India. Yet, awareness about this illness is dismal and Stigma, debilitating. This presentation was used by Dr Milan during his talk at bipolarindia.com's Event in Mumbai on World Bipolar Day, 2017. This comprehensive presentation covers the causes, remedies, symptoms and red flags of the dreaded illness that has not spared even renowned World figures.
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Demystifying Bipolar Disorder
- 1. BIPOLAR DISORDER- DEMYSTIFYING Dr Milan Balakrishnan Bombay Hospital
- 2. Mystery of Bipolar • Syndrome • Causes • Co-morbidities • Inadequate information • Casual use of the term • Misconceptions
- 3. Bipolar disorder awareness • Objectives: • Increase awareness of bipolar disorder (including both mania and depression) • Promote early detection and accurate diagnosis • Reduce Stigma • Minimize the Impact on those who live with this medical illness.
- 4. Bipolar Disorder- Major Public Health Issue • 60 million suffer from BPD with about 9 million in India • DALYS 141.7 /100000 • 1 in 3 get diagnosed • 1 in 3 people with bipolar disorder fail to comply with treatment • Non-adherence to treatment often results in hospitalization and suicide
- 5. Prevalence Rates and Course • Bipolar I • Lifetime: 1 in 100 • = in men and women • Ave. age onset = 20-25 • Recurrent
- 6. What is Bipolar Disorder? Bipolar disorder is a serious mental illness that is characterized by extreme mood swings from mania to depression. Mania is an abnormally elevated mood, while depression is an abnormally low mood.
- 7. Severe mania Hypomania Mild depression Severe depression Moods Alternate Between “Poles” High Lows Normal Mood
- 8. BiologicalApproach The biological approach to bipolar disorder suggests that high or low levels of neurotransmitters such as dopamine, serotonin, or norepinephrine is the cause.
- 10. Case 1: • 35 years old male brought forcefully by family. Since a week had not slept, and had been busy writing a novel, getting banners published and building huge projects. His children were afraid of his aggressive behavior and he had recently started using recreational drugs too. He was usually flirting and acting inappropriately with women. He was fired from his job but he said that he didn’t need it as he was going to launch his own company soon.
- 11. Case 2: • 23 year old female presented with crying spells, no interest in activities, disturbed sleep, decreased appetite, social withdrawal and a suicidal attempt of over- dosing of sleeping pills. • Her mother often suffered from the same symptoms and was diagnosed with bipolar disorder.
- 12. Famous people with bipolar disorder. Beethoven Musician. Abraham Lincoln U.S President Catherine Zeta Jones Hollywood Actress • Winston Churchill- • British Prime Minister. • Isaac Newton- • Scientist • Vincent Van Gogh- • Artist
- 13. Mania Persistent abnormally elevated irritable mood > one week
- 14. Symptoms of Mania Inflated self-esteem/grandiosity Decreased need for sleep Racing thoughts or "flight of ideas" Spending sprees Increased physical/mental energy Irritability/aggressive behavior Impulsive/risk taking Increased sexual drive
- 15. Depression • Feeling down • Loss of interest in enjoyable things • > 2 weeks
- 16. Symptoms of Depression (Cont.) Weight loss/gain Insomnia/hypersomnia Psychomotor agitation/slow down Fatigue/loss of energy Decreased ability to concentrate/make decisions Recurrent thoughts of death/suicide
- 17. Hypomania Mixed state Between Mania and Depression
- 18. Etiological Factors • Hereditary Factors • Biochemical Hypothesis • Stressful Life Events • Family environment • Cognitive Styles as Vulnerabilities
- 19. Triggers Stressful life events Stimulating internal/external environment Excessive Caffeine/ nicotine Alcohol/ drug use Seasonal change Non- compliance with medication Changes in routine Stressful relationships Prolonged untreated or poorly managed illness.
- 20. B.D. comorbidities & Differential Diagnosis • Bipolar vs. unipolar • ADHD • Schizophrenia • Substance abuse
- 21. Prognosis 1. Suicidality 2. Presence of a personality disorder 3. Quality of family and social support 4. Substance use 5. History of severity of prior episodes 6. Bipolar I type is most severe 7. Treatment onset-the sooner the better 8. Age of onset-the younger the more severe
- 22. Management • Seek Help • Early detection of Individual ‘signature’ signs. • Ensure the safety of patient and others~ • Suicidal behavior • Homicidal behavior • Risk taking behavior ( financial, sexual, driving etc.) • Exhaustion
- 23. The Warning Signs of Suicide Talking about death, self-harm, or suicide Feeling hopeless/helpless/worthless Withdraw from friends/family Acting recklessly Putting affairs in order or saying goodbye Seeking out weapons or pills
- 24. Recognize Warning Signs Offer Support/Help/Listen Take It Seriously/Get Them Help How to Help Someone Who is Suicidal
- 25. Treatment • Medication- Mood stabilizers. • Electroconvulsive therapy in acute mania or depression • Psychoeducation for patient and family • Psychological therapy (Interpersonal and social rhythm therapy, CBT & others)
- 26. Monitoring and prevention • Continually monitor psychiatric status • Identify individual’s triggers • Identify early warnings and seek help • Prevent relapse and encourage adherence to treatment.
- 27. Help for care givers • Burnout • Take care of own health- seek professional help for own problems • Family, couples therapy, Group therapy • Join a Support group.
- 28. Self-Help For Bipolar Disorder Monitor your moods Make healthy choices Seek support Keep stress in check Get educated
- 29. Dr Milan Balakrishnan Mindcares Clinic Mumbai +91 9930160068 dr.milanb@gmail.com
Notas do Editor
- Lets talk about how the moods alternate. Along a continuum there is a high end, middle, and low end that reflects a person with bipolar disorder and their mood. There are two opposite polls at each end reflecting very different moods, this is why it is called “bipolar disorder.” A person with this disorder can swing from one end to the other. Mania is at the extreme of one poll, with severe depression at the other poll, with normal mood being in the middle.
- Mania is defined as an episode that lasts more than a week and consists of an abnormally high mood. Sometimes these are the people who are the loudest in a crowd, the most daring, and confident people. At first they can appear happy, energetic, and animated but they continue with this behavior longer than what is considered the norm. This level of high energy physically and mentally takes a toll on their body depleting them of energy when they eventually come crashing down.
- Mania can be displayed in a variety of symptoms. A manic person will not necessarily have all of these symptoms but most likely a few in a variety of combinations. They can feel they are unstoppable, take risks they usually would not take while finding it difficult to sleep due to racing thoughts. Many times they find it is difficult to relax in one place due to the increased physical and mental energy. They can become overly aggressive or irritable and feel a increase in their sexual drive. Due to their impulsiveness some people feel the need to go on spending sprees buying things they want in the moment. These symptoms can lead to dangerous acts and intervention from family and friends is needed to keep the person safe and get them help. People are less likely to seek treatment when they are in the manic phase because they usually do not realize that anything is wrong and most describe it as a good feeling (NAMI, 2011).
- Depression is the other end of the pole. Major depression is defined as a serious medical illness that affects 15 million American adults in a year (NAMI, 2011). It is more then the “blues” lasting much longer affecting the daily life of those experiencing it. People with depression lose interest in things they once loved to do and isolate themselves from others.
- Like mania there are many symptoms of depression and one does not have to exhibit all of them to be diagnosed as depressed. They may eat too much or not feel like eating at all. Some people have difficulty sleeping and others sleep hours and hours through the night and day rarely leaving their beds. They may feel emotionally and physical tired, sometimes unable to get out of bed at all. Decision making is affected because they cannot concentrate well. Feelings of worthlessness and being a burden to others can bring thought of death and suicide. It is in this mood that people with bipolar disorder are more likely to seek help (NAMI, 2011).
- Hypomania is a shorter duration of manic symptoms that are less severe lasting at least four days as is considered a mild functional impairment (Stovall, 2012). People may experience this if they are usually more on the “low” or depressed side and do not have elated manic symptoms. A mixed state is often referred to as rapid cycling because a person they have both depressive and mania simultaneously. Depressed people are more likely to seek treatment and lays the groundwork for diagnosing bipolar disorder.
- Depression can lead to suicide. Steps should be taken to assure a depressed person gets the help they need. These are some of the ways that you can help someone. Make time for a depressed person or it may be too late.
- People affected by bipolar disorder can help themselves through keeping track of their moods, making choices that support wellness and managing stress levels. A plan should be in place for support if the need should arise. Seeking education on their own or through support groups about the disorder can help them understand and manage the disorder, realizing that they are not alone.