Bipolar Disorder

Bipolar disorder is a condition that primarily affects mood, causing swings from extreme elation (mania) to severe depression, with normal periods in between. It was previously called manic depression. ‘Classic’ bipolar disorder affects about 1% to 2% of the population but in recent years the diagnosis has been extended to include those who experience less severe forms of mania – hypomania. There is a good deal of debate regarding the severity of symptoms required to make the diagnosis.

Symptoms

Mania is characterised by:

• Over activity, often associated with a lack of inhibition.
• Racing thoughts and rapid speech (so called pressure of speech).
• Flight of ideas, which is a state where speech moves from one idea to the next so rapidly that meaning is lost, although the link between ideas is still apparent (as opposed to the situation in schizophrenia, where the link is lost).
• Elated mood, which sometimes manifests as irritability and anger.
• ‘Grandiose’ beliefs or delusions, which are of a positive nature. For instance believing oneself to be very famous or rich.
• Hallucinations, usually voices, saying very positive statements reinforcing the grandiose beliefs.
• In general, the symptoms of mania are said to be ‘mood congruent’. They can be understood in terms of the elated mood, such as grandiose delusions. This is the opposite to schizophrenia, where the symptoms are mood incongruent.

The lack of inhibition can be very destructive resulting, for instance, in over spending money to the extent of accumulating significant debts or sexual behaviour that the patient subsequently deeply regrets.

The definition of hypomania is not clear-cut. In general, there is no flight of ideas, delusions or hallucinations and the level of destructiveness is not as extreme.

There are professionals who would consider quite minor symptoms to constitute a hypomanic episode. There is also dispute as to how long an episode needs to last to be considered significant. The generally accepted time is 4 days but again, there are many who would accept a much shorter period of time in making a diagnosis.

In bipolar disorder there are discrete episodes of mania/hypomania alternating with depression, with normal periods in-between.

Depressive symptoms in bipolar disorder are exactly the same as those in depression (so called unipolar depression). However bipolar depression, defined as depressive episodes occurring with at least 1 episode of mania or hypomania, has some differences from unipolar depression:

• It is quite possible that bipolar depression responds less well or not at all to anti-depressant medication.
• There are risks using antidepressants as they can precipitate an episode of mania/hypomania, so called 'switching'. For this reason the guidance is that antidepressants should not be used without either a mood stabiliser or antipsychotic medication.

Another feature of bipolar disorder is that there may be so called ‘mixed episodes’ where an individual has symptoms of both mania/hypomania and depression.

It was thought that patients returned to complete normality during the periods between episodes in bipolar disorder. However, it has come to be recognised that in severe forms of the disorder there are subtle changes, similar although generally less severe than the ‘cognitive’ symptoms seen in schizophrenia, that are apparent between episodes.

Best Evidence-Based Treatments

Medication is considered a key component of the treatment of Bipolar disorder and the National Institute of Health Care and Excellence (NICE) recommends certain psychological therapies. The experience of bipolar disorder can be very challenging for both patients and those around them and it is important to understand the disorder and how to prevent and manage relapses.

The treatment of the less severe forms of bipolar disorder, associated with hypomania rather than mania, is similar but at what point medication is indicated is not at all clear.

Recommended psychological treatments are:

Specific Therapies:
There are a number of approaches. All are based on increasing understanding of bipolar disorder and on recognising early warning signs and ensuring early treatment of relapses.

All the therapies recommended for depression apply to treating the depressive episode of bipolar disorder.

Pharmacological:
The main medications used in bipolar disorder are

• Anti-psychotics: These medications were developed for use in schizophrenia but are also effective in mania/hypomania. Many of the newer agents, the 'atypicals', are also licensed as mood stabilisers and anti-depressants (see below).
• Mood stabilisers. The first of these agents was lithium and various other medications, developed for epilepsy, are also effective. They can be used to treat mania/hypomania and depression and also to prevent relapses.
• Anti-depressants. As mentioned above, the role of anti-depressants in bipolar disorder is not clear and certainly more limited than in unipolar depression.

Elite Psychology comprises of an expert team, specialising in the range of best private evidence-based therapies for bipolar disorder. Our highly qualified associates are accredited in all of the most successful therapies, complemented by psychiatrists who can prescribe medication on private prescriptions. We can assess you and provide the most efficacious therapy tailored to your difficulties. We know the importance of being understood, and endeavour to deliver the highest standard of psychological interventions to meet your needs.

Call us on 020 3815 7935 for further information or to book an assessment. Alternatively you can complete the online contact form.