Bipolar disorders

Bipolar or not bipolar?

  • We all experience bipolar mood.
  • Only 1% of the general population suffers from typical bipolar disorder and 2 to 3% from an attenuated form (bipolar spectrum), therefore some 1.5 million people in France.
  • The medical notions of mania and melancholy date back to Antiquity, however, the modern-day description of manic-depressive disorder dates back to the end of the 19th Century.
  • The term bipolar disorders was coined at the end of the 1980s.
  • The disorders begin in most cases in late adolescence and early adulthood.
  • Women are affected as much as men, however they present with more depressive episodes and the outcome is often less favourable.

The cause of bipolar disorders:

  • Bipolar disorders are not genetic.
  • Several factors (some of which are genetic) are involved in its development.
  • Abnormal function of the brain networks involved in mood regulation is today clearly identified by brain imaging studies.
  • Emotional hyper-reactivity is a symptom of the temperament of bipolar patients which is seen during episodes.
  • Expression of the disease results from an interaction between stress, emotional trauma and pre-existing cerebral vulnerability.

The symptoms of bipolar disorders:

  • Bipolar disorders are characterised by cyclic mood phases, manic or depressive, which mark the break with the subject’s normal function.
  • Manic episodes involve highly intense mental and motor agitation which most often leads to hospitalisation.
  • Hypomania is an attenuated, but nevertheless pathological, manic episode.
  • The depressive phase of bipolar disorder can be dominated by severe motor slowing or characterised by emotional and behavioural instability.
  • Manic and depressive symptoms can be combined during episodes, they are therefore known as mixed characteristics.
  • Between episodes, residual symptoms sometimes persist and affect patients’ quality of life.
  • Poor knowledge of the pathological nature of the disease at onset, and during certain episodes, may mean patients have to be hospitalised and treated without their consent.
  • During progressing bipolar disorder, if the patient’s autonomy is affected, protection measures (legal safeguard, curatorship, guardianship) may be required by a judge.
  • Bipolar disorder does not make the bipolar disorder sufferer dangerous to others, except if the disease is complicated by addictions to toxic substances.
  • One in two bipolar disorder sufferers fall victim to substance addiction (alcohol, tobacco, cannabis, cocaine).
  • 10% of people with bipolar disorder die by suicide.
  • Life expectancy is reduced by around ten years compared to the general population.
  • Borderline, schizoaffective and attention deficit and hyperactivity disorders are on the verge with bipolar disorder.
  • Anxiety disorders and eating disorders may be related to the bipolar condition. Somatic diseases (cardiovascular, endocrine or neurological) may aggravate the outcome of bipolar disorders.

Bipolar disorder treatments:

  • Personalising care consists of taking the patient’s age and sex, the number of episodes (manic, hypomanic, depressive), and tolerance to drugs already prescribed into account in the choice of treatment and therapy.
  • Medical treatment is essential for controlling bipolar disorder. It is necessary in the very long-term.
  • Lithium is the gold standard drug, even if it is often prescribed in combination with other molecules.
  • Episodes should be treated differently from relapse prevention.
  • Psychological management plays a major role in improving the disease prognosis and patient quality of life.
  • Biological treatment sand psychotherapy should be combined to effectively treat bipolar disease.
  • A specialist should monitor patients over the long-term.
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