Bipolar Disorder is essentially a disorder of the brain. It predominantly affects a person’s mood and causes a lot of unnecessary negative stress to family members, friends or even colleagues.
The symptoms of Bipolar Disorder are varied and depend on its phase and severity. The swings in different mood states of bipolar often results in disruptions in one’s personal, social or occupational life. Relationships are damaged, work is affected, studies/school performance is compromised and family or marriage institutions are severed.
Bipolar Disorder usually rear its ugly head in early adulthood, some are inflicted by it in their teenage years. Some develop this illness in the later years of their lives. Most of the time, the symptoms of bipolar disorder go unrecognised and it may be mistakenly thought as part of a person’s “bad behaviour”, “ill-character”, “bad attitude”, “challenging personality”, “difficult to put up with” etc. All the terms mentioned above are not unusual for people who have no knowledge regarding the illness and they use these terms to describe bipolar patients. Sometimes, the diagnosis of bipolar is by itself a challenge to the treating psychiatrists/physicians.
The term “bipolar” denotes the two phases or facets or “poles” that generally appear in the course of this debilitating illness.
During the manic phase, a person with Bipolar Disorder may exhibit manic symptoms eg increased energy level, reduced need for sleep at night, irritability, agitation and restlessness, talkative, argumentative, boastful talk, over-confident, over-ambitious or grandiose feeling, unrealistic thoughts and ideas, impulsive and rash in their action. More often than not, manic patients will have impaired judgement in making decisions and tend to delve more in high risk activities or decisions which they may regret later.
In the depressive phase, the same person will experience the “opposite pole” of bipolar in that the mood state will plunge to being depressed. In this state, the symptoms of depression will manifest: loss of interests in most activities, socially withdrawn, lethargic and tired, unable to concentrate/focus, loss of appetite, sleeps most of the time, feeling lazy and down, worried and forlorn, guilty, hopeless and helpless or even suicidal.
Either manic or depressive phase, a bipolar patient will experience the symptoms mentioned above for most days of the week for a week or two and in some cases, may stretch to even months before being recognised and diagnosed.
Treatment for Bipolar Disorder
Treatment is comprised of combination of both pharmacological and psychological treatments. A psychiatrist or a physician having the expertise to treat bipolar disorder will first have to diagnose accurately as this will determine the outcome of the treatment. Up until now, there is no definite cure for this illness but effective treatment to better control the mood symptoms are easily available for patients and family members.
Treatment plans depend on the individual case and the severity and/or the phase of the illness. Acute treatment aims to alleviate the acute symptoms and helps to stabilise a patient who requires more urgent attention. Sometimes, hospital admission for in-patient treatment is necessary for the sake of the patient who is at risk of harming others or even himself/herself. Hospital or ward admissions do not necessarily mean that the patient “has lost it” or “has gone cuckoo”, but it is more dire at that point to warrant him/her a safe sanctuary from the gripping symptoms of mania or depression of which even family members are unable to provide.
Pharmacological treatment
In pharmacological treatment, a person needs to take/consume some medication prescribed by the psychiatrist. The medications are usually a combination of antipsychotics, mood stabilisers, antidepressants and tranquilisers. Some minimal side effects may occur with some medications, however it is imperative and important that the patient discuss with his/her treating psychiatrist before deciding to stop or reduce medications. Patience is a virtue when it comes to waiting out to see the expected improvement or response from treatment.
Psychosocial Treatment
Psychosocial treatment works hand-in-hand with (pharmacological treatment) medications to provide stability in mood and help in regulating daily functioning. Psychotherapy is a form of psychological treatment rendered by psychiatrists to patients with mental, emotional and/or psychological disorders. There are various types of psychotherapies used for patients with Bipolar Disorder. Psychoeducation, Interpersonal Therapy (IPT), Cognitive Behaviour Therapy (CBT), Interpersonal and Social Rhythm Therapy (IPSRT) are some of the types of psychotherapy provided for patients. In most cases the psychiatrist will recommend or advocate the relevant psychotherapy deemed beneficial or necessary for the patients or even family members. The role of clinical psychologists, counselors and occupational therapists are also important to help support patients towards achieving stability in their mood state with recovery as the main aim.
Electroconvulsive Therapy (ECT)
This is a form of electricity/current shock treatment given to patients who are in acute manic state or depressive phase. The doctor will call for/recommend ECT treatment in cases where :
- You are severely unstable and unable to wait for medication to work.
- Medications do not work for you.
- Medications are not suitable for you in certain medical conditions eg pregnancy, breastfeeding or having other medical illness.
If Crisis Happens
If the illness is poorly controlled, a patient will become unmanageable with higher chance of developing erratic and dangerous behaviour such as excessive spending, reckless driving, aggression, self-harming etc. Therefore, before a crisis happens,
- Ensure you and family members are well-versed with all the early warning signs of the illness. Please see the box below.
- Seek medical help as soon as possible once you feel like your mood or energy level has changed.
- Have a crisis plan on what to do when a crisis happens eg when or who should bring you to the hospital.
- Keep important telephone numbers available for use should a crisis develop.
- Always ascertain that the environment is safe for you or your loved ones.
- Early warning signs:
What Can You Do To Maintain Wellness with Bipolar Disorder
- Take your medication regularly as prescribed by the psychiatrist. Do discuss with the doctor regarding the possible side-effects or any queries on the medications. Do not deliberately skip or alter dosages on your own. Good adherence to treatment (medications and/or psychosocial) is of utmost importance and determines the outcome of illness management.
- Maintain a good sleep hygiene each night. Regular pattern of sleep, both in terms of quantity and quality plays a vital role in controlling Bipolar Disorder.
- Stop or reduce smoking and alcohol intake.
- Do not take caffeine or illicit substance/drugs that may disrupt your mood, sleep or medication.
- Check your mood regularly with your own mood chart. Discuss this with your doctor if you need help in devising one.
- Maintain a regular/structured life pattern and daily routine.
- Exercise regularly.
- Try to reduce and manage daily stress, be it at home or at workplace.
- Learn to identify the early warning signs of relapse.
- Join a support group.
Conclusion
Bipolar Disorder is a common medical condition. It is basically a mood disorder that can have a debilitating effect on a person’s life. It can severely impair one’s daily functioning and cause great disability in other aspects of your life. Various factors and reasons can precipitate the illness, stress being one of the main culprits. Treatment for Bipolar Disorder is multi-pronged and needs concerted effort from the multidisciplinary team of mental health professionals. Road to recovery is well-paved and has been well-trodden thus far. The stigma towards Bipolar Disorder as well as other mental/psychological disorder is the only hindrance towards achieving recovery. Act now, end the stigma as mental health is everybody’s business.
Dr Chong YS
B.Sc (UPM)
MMED (UKM)(Psychiatry), MD (UNHAS)
Hospital Pantai Ayer Keroh
