Manic-depressive psychosis. What is it, Symptoms and Treatment

Manic and depressive phases - a key feature of development in human bipolar disorder.

Psychosis is very dangerous for the health of the patient, so if you have the first signs of the disorder the patient must consult with your doctor for the appointment of the total treatment, which will increase the probability in the minimum possible time to restore normal the functioning of the psyche.

What is manic-depressive psychosis

Manic-depressive psychosis - a type of mental disorder that involves periodic alternation depressive and manic states of depression or mania periods separately or simultaneous occurrence of their symptoms.

In the middle of the XIX century. France were first concepts explaining the nature of the disease, open two psychiatrists who called circular psychosis disorder. Their ideas had a significant impact on the German researchers, which was manifested in the activities of the German psychiatrist Emil Kreplina, who developed his own concept of illness.

Thanks to his manic-depressive psychosis became an official part of nosology - teaching about diseases.

In 1993 after the revision of the classification of international disease deviations name "manic-depressive" recognized not quite correct, which it is associated with the stigma of the disease in relation to their suffering and its heterogeneity manifestations.

Today, the disease is termed "bipolar affective disorder", but still not it exists only accurate determination of the difficulty in understanding the boundaries psychiatrists disorder. Evaluation of the prevalence of disease is ambiguous because of a subjective diagnosis of psychiatrists and expanding the criteria for bipolar disorder.

Foreign studies have shown that the probability of sick disorder, on average each person is equal to 2%. With about half of patients with rejection - people from 20 to 40 years old.

The disorder is also beginning to actively manifest after the age of 50 years; a similar pattern is confirmed and, according to statistics, about 20% of older people are faced with the first symptoms of bipolar disorder.

Kinds

There are 2 types of affective disorders: bipolar and unipolar. The second type includes periodic mania, including manic alternating bouts of depression and periods. Bipolar disorder is classified depending on the frequency and nature of the flow of opposite states of mind.

Type of bipolar disorder	Description
Correctly-punctuated	Manic and depressive periods follow each other at regular phase mental recovery.
Wrong-interleaved	Lack of priority manic and depressive phases; after the depression period of the phase of normal mental activity, then it can reappear depression.
Circular	The regular alternation of the two phases of the disorder, characterized by the absence of periods of intermission, the normal state of mind.
Double	Manic and depressive period immediately follow one another, followed by a intermission.

Stage and grade

For each of the two periods, alternating with manic-depressive illness, is held in different ways and is characterized by certain stages.

Manic phase characterized by:

• elevated mood;
• mental excitement;
• increased physical activity.

Stage manic period:

1. Hypomania. Stage differs enhance the mood of the patient, sometimes accompanied by irritability. At the same time there is increased physical and mental activity and performance. State characterized by distractibility, and the ability to memorize information. Sleep patient becomes uneasy and short-lived, it increases appetite.
   
2. Severe mania. Observed in hypomanic symptoms begin to appear much more active. The patient starts to constantly make jokes or be expressed anger. It had become very excited, thoughts are cut off abruptly and jump to other ideas. The patient is often distracted and can not concentrate on the conversation, he begin to appear delusions of grandeur, grandiose plans and prospects. Sleep in a patient lasts about 3-4 hours.
3. maniacalFury. Step differs severe symptoms of previous stages. The patient's speech becomes slurred, he observed the sharp motor movement.
4. Motor sedation. During the motor manifestations of sudden calm and excited movements begin to significantly decline. Active speech patients with elevated mood remains practically unchanged.
5. Reactive stage. The symptoms of this phase are gradually beginning to subside. The patient returns to the previous state and can not remember the manic episodes of maximum excitation.

Depressive period is different:

• motor retardation;
• apathetic mood;
• slow response of thinking.

Stage of the depressive phase:

1. Elementary. The patient starts to decrease mood, level of physical and mental performance. Also, the patient begins to have trouble sleeping.
2. increasing depression. The patient's condition characterized by increased anxiety, lethargy and a clear intensification of the doldrums. The patient has decreased appetite; he begins to suffer from insomnia.
3. Severe depression. The patient begins to experience psychotic anxiety reactions and depression. His speech is slowed down noticeably interrupted and becomes monosyllabic. In the mind of the patient appear delusions associated with self-hatred, self-blame, and hypochondria. Perhaps the emergence of suicidal patient, frequent attempts to commit suicide.
4. reactive stage. Step differs gradual disappearance of depressive symptoms; in cases of hotel small excitation may occur, mental and physical activity.

symptoms

Manic and depressive symptoms of psychosis characterized by specific symptoms, in which analysis can understand the patient's current phase. During the period of mania, the patient ceases to notice the negative aspects of his life; any difficulties appear to be minor because of his confidence in his infinite possibilities.

Constant stimulation interferes with their sleep, that does not stop the patient to realize Great, in his opinion, the plans that, with the development of the manic phase, become delusional and intrusive. It the patient becomes agitated and fast, and eventually illegible because of the large flow of patient thought, does not manage to verbalize them through.

A clear symptom is also an activity that differs sharp and fast movements excited, seemingly beyond the control. Constant need of the patient in activity often leads to hypersexuality, which is most often seen in young people in a manic phase.

During the depression period, the patient loses interest in life, and has no desire to be any activity. Its efficiency is sharply reduced, as interest in any activity. Condition characterized by frequent manifestations of "depressive stupor" when the patient stands still in the same position and is in it for a long time.

the patient's depression can manifest itself along with hypochondria, a constant concern for their health. Characteristic of a depressive period, suicidal thoughts, sometimes leading to suicide attempts. The patient may suffer from hallucinations, usually auditory, manifested in the form of voices talking about the meaninglessness of existence.

Problems with appetite can lead to symptoms of anorexia, lack of sleep and problems with attention and memory. There are specific cases where the patients gain weight and suffer from excessive sleepiness. Both extremes have a negative impact on health, which becomes difficult to recover even after the depressive phase.

Causes of

The causes of the disorder before the end completely understood, but recent research has highlighted the particular importance of genetic factors in the development of the disease. Despite this, a significant role played by psychosocial factors, the development of the disease should be considered by both biological and social reasons.

Genetic factors:

1. Despite an incomplete picture of the role of genetics in the development of the disorder, there are data which show dominant gene whose adhesion to the X-chromosome may be responsible for predisposition disorder.
   
2. Studies of families of the genome in which patients have manic-depressive psychosis, revealed the existence of certain genes, each of which greatly increases the risk of disease.
3. Samples of brain dead patients suffering from bipolar disorder showed a single expression of certain enzymes, which also differ in brain analysis of patients with schizophrenia. However, researchers have not come to the same conclusion, whether such change is due to pathology or medication.
4. Data on the study of identical twins showed the proportion of the influence of genetics and environment environment in the development of the disorder: the contribution of social factors proved to be no more than 10%, the hereditary factor - 80% and more.

Psychosocial factors:

1. Research on the basis of sex differences differences of the disease has shown that bipolar disorder is manifested, in most cases, in men; Women are more prone to unipolar psychotic manifestations. Also, women are more likely to suffer from the disorder because of menstruation and post-natal condition. Postpartum depression in women are more able to lead to the development of the disease.
2. Provoke disorder ability of other mental disorders. Previously existing psychiatric problems are likely to lead to a manic-depressive psychosis.
3. Personal features influence the risk of developing the disease. Schizoid personality traits (the closure in yourself, avoiding contact, the tendency to loneliness and care imagination) increase the risk of developing the disorder (70% unipolar psychosis; 30% - of bipolar disorder). Also melancholic personality traits can lead to mental disorders.

Diagnostics

Manic-depressive illness is difficult to diagnose because of its relatedness to other diseases similar pathogenetic mechanisms (especially the origin and flow). It is therefore recommended differential method based on the exclusion of all possible diseases that leads to only one possible embodiment of deflection for diagnostic experts.

The main criterion for determining the bipolar affective disorder - the presence of two phases: the manic and depressive.

But the definition of the disease is actually much broader and includes a number of features:

1. In the diagnosis of the patient is necessary to consider the adoption of psychoactive substances or antidepressants, which could trigger a manic state.
2. During the manic phase the patient is suffering from speech and motor excitation, which may lead the physician to the diagnosis of schizophrenia. In this case, the wrong medication can aggravate the patient's condition.
3. State of mild mania in a patient can be treated by doctors as symptoms of major depressive disorder. Depressants wrongly prescribed by doctors, the disorder can disrupt the cycle and lead to patient disability.
4. An important criterion indicating bipolar disorder - especially the patient's response to the adoption of anti-depressants. The patient either does not respond to medication or switch to mania stage.
   
5. In the diagnosis of the disease should pay attention to a family history of the patient, presence of predisposition to the disorder, according to family members of substance.
6. Identify disorder by using questionnaire mood disorders, bipolar spectrum diagnostic scales and samooprosnika diagnostic status hypomania.

When to see a doctor

Most patients are drawn to a psychiatrist with specific complaints:

• depressed mood;
• problems with appetite;
• insomnia;
• frequent changes of mood;
• decreased ability to concentrate;
• obsessions.

In addition, in the event of such symptoms should pay attention to the co-morbid conditions that appear along with the main.

For example:

• increased anxiety;
• alcohol consumption;
• substance dependence;
• inability to control their behavior.
• frequent trouble with the law;
• increased impulsivity.

Consult a doctor if a psychiatrist is necessary to first occurrence of basic and associated symptoms of bipolar disorder. rather complicated diagnosis of the disease and includes many specific features, so you need to prepare for treatment, collecting family history.

It is necessary to analyze the conditions for the appearance of the first symptoms of rejection (whether they were accompanied by stressful / traumatic events) and highlight the features of their display (if there is change manic and depressive phases whether recovery periods mental condition are observed, the effect of drugs on switching from one period to disorders other).

prevention

Manic-depressive illness - a disease that may be caused by a genetic predisposition, so people relatives who have suffered or suffer from bipolar disorder, you must constantly monitor their mental state.

In the absence of risk of disease predisposition becomes lower, but traumatic events, post-partum depression and other mental problems may provoke disorder.

In any case, for the prophylaxis of bipolar disorder need to be seen by a doctor therapist who can:

• notice the first signs of abnormalities;
• develop the human consciousness;
• work through injuries and difficult situations;
• get rid of the obsession;
  
• to develop a course of medication (if necessary).

Also the prevention of disorder can be a beneficial social environment, are always ready to help and support him in difficult situations, and a healthy lifestyle, which has a positive effect on mental health and general health body.

When the first symptoms of manic-depressive psychosis should immediately consult a therapist who, for suspected bipolar disorder, refer the patient to a psychiatrist for the development of treatment programs and making course drugs.

therapies

Treatment of manic-depressive psychosis includes taking drugs and folk therapy methods to alleviate symptoms.

The course of treatment is determined only by the attending physician, which is associated with worsening of the patient for self-treatment. Types of drugs and their dosages are always individual, so to assign courses of drugs without a specialist strictly forbidden.

Medications

Drugs in bipolar disorder include:

1. preparations Li. Psychotropic drugs lithium taken in periods of mania. Its action is aimed at reducing impulsivity and aggression, but the action only begins to emerge receiving on day 5, and the drug is used as an additional tool to date with other medications.
2. valproic acid. The drug is taken in periods of acute mania. The results of the drug showed its high efficiency on a par with lithium when beginning its reception with saturated dose - 20 mg / kg. When used properly, the drug reduces the duration of affective manic periods.
3. carbamazepine. The drug used in both the manic and depressive phase of a disorder. He is faster and more efficient lithium, neuroleptics, but more slowly, so treatment with carbamazepine is held together with other drugs.
   
4. lamotrigine. The drug, in contrast to lithium and valproic acid is effective for the treatment of depressive disorders periods. Antiepileptic drug is, and its mechanism is intended to block the excess emissions of excitatory amino acids.
5. quetiapine. The drug is a neuroleptic, and is recommended for short-term treatment during manic periods. Its action is aimed at combating negative symptoms of acute mania; it is, in contrast to lithium, has far fewer side effects.

Traditional methods

Traditional methods in manic-depressive psychosis are not the primary therapeutic agent, taking them as the an additional way to mitigate the symptoms of the disorder, and specific national methods should be agreed with your doctor.

Folk remedies for bipolar affective disorder:

1. Tea to reduce anxiety. tea recipe helps get rid of stress, headaches and improve digestion. For preparing a beverage The following ingredients must be mixed in such proportions: melissa 0.25; 0.5 parts of peppermint; 4 pinches lemon rind; 0.25 parts of hyssop anise; 1 stalk lemongrass; 1 tablespoon the resulting mixture must be filled with 1 liter of boiling water, to give a tea brew no more than 10 minutes. The resulting tea can be drunk throughout the day.
2. Blooming Sally. Recipe tincture of herbs helps to get rid of some symptoms of the disorder - insomnia. To prepare the solution must make 15 g Ivan tea and infuse it for at least 9 hours. Next, you need to filter the next drink and drink before bedtime.
3. Herbal camomile tea. Chamomile - a proven and safe remedies for depression. Tool helps reduce irritability, and get rid of insomnia. Tea is necessary to take 1 tbsp chamomile flowers, sugar and 1 liter of boiling water.
   
4. soothing oil. Tool will help reduce irritability and hyperexcitability. To use the need to mix 200 g of blooming mignonette and 0.5 liters of sunflower oil. The resulting liquid insist about 2 weeks in a cool room, periodically shake. When the time to use a solution rubbing a small amount in the whiskey not more than 2 times per day.
5. Lavender syrup. This tool will be useful in the treatment of depressive period; Lavender helps to reduce anxiety, migraine and prevent diseases of the gastrointestinal tract. To prepare the syrup is necessary to take fresh lavender top (approximately 200 g) and cover them with 0.5 liters of boiling water. Writing the obtained mixture brew for about one day after the time of its drain. The resulting infusion boil and pour it again taken 200 g of lavender tops, allow the mixture to infuse again. The resulting liquid is necessary to add 0.5 kg of sugar, mix and cook at low temperature to the state density. The resulting syrup is applied several times a day.

Other methods

Manic-depressive psychosis - is, above all, a mental disorder, you are working with a psychiatrist. In addition to the medicinal and traditional methods, the patient must undergo psychotherapy, through which it is possible to cure the disorder. There is no universal method that is appropriate for all patients with manic-depressive psychosis.

But the most well-known for its efficiency are:

1. Cognitive-behavioral therapy. It allows you to identify and explore their ideas in manic periods of mania and suicidal tendencies during a depressive phase. Identifying cognitive error of his thinking during periods of mania and depression - an important element of cognitive-behavioral therapy; This helps the patient to independently analyze their symptoms, and therefore makes it easier for him the opportunity to fight with them and monitor their activities.
2. Dialectical Behavioral Therapy. It is a modified form of cognitive-behavioral therapy, adapted for the treatment of affective disorders. Therapy is aimed at identifying their emotions their understanding and accommodation. The basis of working with patients is aimed at understanding and learning basic life skills: conscious attention; control of the suffering living; able to regulate their emotions; getting healthy communication skills.
3. Family therapy, art therapy. These therapies are optional, but useful for the study of emotions and their relationships with people. Bipolar affective disorder - a difficult decision for the patient's loved ones disease, so family therapy will help the patient to establish contact with his family. Art therapy - a way to the patient to express their emotions through art, which is an important additional part of the core of psychotherapy.

   

4. Therapy acceptance and responsibility. Six key principles are used in the treatment of:

• Separation of (non-fusion). The principle is the ability to view your thoughts by trying to exclude the involvement of them and emotional ties. Separation from the negative thoughts and the ability to watch them helps to get rid of their ability to greatly influence the patient's condition.
• Adoption. Here we must give space to their feelings, obsessive desires and unpleasant feelings. The principle is the lack of suppression and control; the patient must take the presence of negativity in yourself to productively work out with the doctor.
• Contact with the present moment. In this case, it is shifting the focus of attention of the patient with the problems of the past and worrying about the future, the state of "here and now".
• The position of the observer. The principle allows to look at the experiences of the observer, to move away from the emotional component of the problem and consider them with the greatest objectivity.
• Values. This component of the therapy helps to refer to themselves and understand their deeper values ​​and aspirations.
• Proactivity. Principle helps set goals based on identified values, and highlight ways to achieve them.

possible complications

The absence of complex treatment of disorders can lead to aggravation of the symptoms of manic and depressive phases.

At advanced stages of the patient:

• commits suicide attempts;
• It may cause harm to others;
• gets too excited, his speech becoming incomprehensible to others;
• drink alcohol in large quantities;
• becoming addicted to drugs and other psychoactive substances.

These consequences are deadly for both the patient and the people around him, so in manic-depressive psychosis must be timely and comprehensive treatment.

Manic and depressive phases appearing in psychosis, bring suffering to both the patient and his loved ones. Not to bring disorder to extreme severity, it is necessary already at the first symptoms contact a specialist to start complex treatment.

Author: Anna Fleyman

Registration of the article: Lozinski Oleg

Video of manic-depressive psychosis

Manic depression or bipolar disorder, especially: