Bipolar Disorder - folie à double forme

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Most of us might have heard the word bipolar disorder used to describe a person who has mood swings or moody, but this colloquial use of the term is different from what it means.

It is a mood disorder in which the patient experiences major highs and lows. The highs are described as the manic phase, and the lows are the depressive phase. In early times, bipolar disorder was described as a manic depressive illness, which we don’t use right now.

For those who don’t know what mania and depression are

In short, mania is over the joyful or excited state. Depression is an extremely sad or hopeless state.

A mania patient can be spotted by observing the following behaviors:

• Talking too fast
• Easily distracted
• The mood is agitated, elated, or euphoric
• Having little sleep but a lot of energy
• Unrealistic belief in one’s ability
• They behave like they are on top of the world

During the depressive phase, the patient might show one or more of the following features:

• Feeling tired and irritated
• Problem concentrating with low energy levels
• Change in eating and sleeping habits
• Suicidal thoughts or attempt suicide.

The seed to bipolar disorder

It is mostly unknown, but in most cases, it is familial and can also be induced by drugs and medications like selective serotonin reuptake inhibitors (SSRIs).

The brain generally maintains a strong connection between neurons, thanks to the brain's continuous efforts to prune itself. Researches using magnetic resonance imaging have shown that in bipolar disorder, the brain's ability to prune itself is reduced.

Types of bipolar disorder

• Type 1: The patient experiences an episode of severe mania lasting for seven days. Followed by severe depression, lasting at least two weeks.
• Type 2: It is characterized by severe depressive episodes shifting back with hypomanic episodes, but no full manic or mixed episode is seen.
• Cyclothymic disorder: It is a milder form of bipolar disorder where the patient experiences milder episodes of depression and mania.

Diagnosing the patient

It is based on clear evidence of episodes of depression and mania or hypomania. He/she may also have associated symptoms of delusion and hallucination.

Some examples to understand better,

1. She said her roommate was lying on the bed for days and that she had no energy or motivation to do anything and always wanted to sleep (depression phase).
2. He came for a medical check-up. He was charming, but his speech was so rapid that the practitioner couldn’t keep up with him (manic phase).
3. She talked about her ongoing sports practice, novel, and education and said all those were not a big deal (manic phase).

What happens if you don’t treat them on time?

They are more likely to use alcohol and drugs, get into illegal activity, difficulty coping with their work, and lose their job. These patients mostly fail in the relationship ending in divorce. They also pose a serious risk of hurting themselves and also others and at last end up with suicide.

How to help a bipolar patient?

All that you need to do first is to stabilize the patient's mood using mood stabilizers like lithium (in the form of lithium carbonate). This is a commonly used drug, hence describing it in a detailed manner,

You might have heard about lithium while studying the periodic table and wondering how this would help treat bipolar patients.

Lithium mainly inhibits the breakdown of inositol monophosphate to inositol. This results in a decrease in free inositol. Subsequently, a decrease of pip2, which is the precursor of secondary messengers, in mania patients, there is an increase in activity of pip2, so treatment with lithium is expected to decrease the activity of these pathways and relieve mania.

The side effects of lithium can be remembered with the word lithium itself,

L, I      - Leukocyte is increased

T         - Tremor

H         - Hypothyroidism

I, U      - Increased urination

M        - Marriage (contraindicated in pregnancy)

Adjuvant therapy with antipsychotic drugs like risperidone, olanzapine, quetiapine, haloperidol can be given. They help in correcting the biochemical abnormalities, and specifically, quetiapine has been effective against bipolar depression. These drugs are used: as prophylactic or maintenance therapy.

Other mood stabilizers include:

• Sodium valproate
• Carbamazepine
• Benzodiazepine
• Lamotrigine

Psychosurgerical modes of managing bipolar disorders are used as a last-ditch stand reserved for patients who are refractory to other modalities of treatment.

Surgeries include,

• Stereotactic subcaudate tractotomy
• Limbic leucotomy

Last but far from the least, supporting the patient with the following psychological therapies can also help a lot:

• Cognitive behavior therapy
• Interpersonal therapy
• Psychoanalytic psychotherapy
• Behavior and group therapy
• Family and marital therapy

References:

1. Davidson’s Principles and Practice of Medicine 23^rd edition; page no: 1199-1200.
2. Ahuja’s A Short Textbook of psychiatry 7^th edition; page no: 69-82
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963467/

Author’s Footnote

The term “folie à double forme” literally translates to dual-form insanity - a term used in the 1850s by Jules Baillarger, a French Psychiatrist, as an early conceptualization of manic-depressive illness.

Would you believe that creativity and mental illness coexist in the same person?

While personal thoughts may vary in this regard, there is reason to believe so. There has always been a greater association of bipolar disorder in creative professionals. Justifying the statement with some examples:

1. Sir Issac Newton (Physicist)
2. Lord Byron (Poet)
3. Vincent Van Gogh (Painter)
4. Charles Darwin (Naturalist, Biologist)

Feel free to click on the references for a more in-depth reading if you so desire. 

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