To understand Bipolar Mood Disorder (BMD) it is essential to differentiate it from mood swings or extreme emotions that change rapidly. Extreme emotions and mood swings are symptoms that can be present in other psychiatric disorders; however, BMD also involves changes in an individual’s cognitive functioning, bodily desires and physical behaviours.
In BMD the changes in the person’s mood cannot always be explained by recent circumstances and feels incongruent in terms of what is realistically happening in their lives; the symptoms are also sustained over weeks and months and thus have a huge impact on the person’s ability to function in their daily lives.
As the name “Bipolar” suggests – the two poles of moods (mania/elevated mood and depression) have to have been experienced within an individual’s life for the diagnosis of Bipolar to be made.
There is no medical test to confirm that a person is suffering from Bipolar; however, tests can be run to rule out any medical implications that may mimic symptoms similar to those seen in Bipolar.
It is therefore essential for an accurate diagnosis to be made; a person needs to consult a doctor, preferably a psychiatrist that has an understanding of Bipolar as the diagnosis of Bipolar can be difficult to be made.
This is because it relies on an accurate account of the experiences of the individual and often the individual suffering from Bipolar is unaware of the impact the symptoms are having; therefore, it requires a knowledgeable doctor to gain a thorough history. This is where the family and friends also play an important part in being able to identify signs and symptoms.
What causes Bipolar
Typically an individual is genetically predisposed to Bipolar Mood Disorder in that someone else in the family has been diagnosed with a mood disorder or a psychiatric illness.
Environmental factors/stress also play a role in the increased likelihood of the onset of Bipolar. Recent studies have shown an increase in the prevalence of Bipolar in our younger population (individuals under the age of 45 years) with most often the initial episode of Bipolar being at the age of 18 years old.
This can be explained by the lifetime changes one experiences at this age all of which can be perceived as stressful (relationship stress, studies, school performance, and career choice). Stressful developmental milestones and life changes that can impact an individual at other stages of life include marriage, divorce, loss of job, career change, and loss of a loved one. Increased stress levels appear to lower a person’s threshold thus making them more susceptible to any illness.
This should not be seen as a weakness or interpreted as an inadequacy as it often is, but rather allow the individual suffering from BMD to enjoy the same support and understanding as the individuals suffering from a physical disorder that will equally be more likely to manifest when the individual is experiencing high stress levels.
Other contributing factors that increase the likelihood of the onset of Bipolar include Psychosocial Factors (poor self image and low self esteem), substance use and certain physical illnesses such as HIV, dementia, endocrine (hormonal) disorders and brain injuries.
What are the obvious signs and symptoms that will help me identify Bipolar
As noted above one cannot assume a person suffers from Bipolar by merely observing the change in a person’s mood and emotions. It would be important to note the following:
MOOD DISTURBANCES
MANIA: Elevated mood, can also be more irritable or angry or agitated
DEPRESSION: Low mood, emotional blunted, decrease in pleasure and general disinterest and
persistent sadness
VEGETATIVE DISTURBANCES
MANIA: Decreased sleep, increased appetite, increase in energy and increase in libido
DEPRESSION: Fatigue, Increased sleep , poor appetite and low libido and difficulty in engaging with others at all. Can even struggle to make or maintain eye contact.
COGNITIVE DISTURBANCES
MANIA: Racing thoughts, rush of ideas, irrational thoughts often grandiose/religious. Inflated self esteem, poor concentration, poor judgement and inappropriate decision making and problem solving
DEPRESSION: Slow thoughts or what can feel like no thoughts at all. Negative thoughts and difficulty seeing any positivity especially around themselves (very low self esteem). Poor concentration, poor memory, difficulty making decisions and an increase in suicidal thoughts
PSYCHOMOTOR DISTURBANCES
MANIA: Very restless and moves quickly. Difficulty sitting down for long periods of time. Increase in risk behaviour (substances and sexual activity) and difficulty in stopping them and feels out of control
DEPRESSION: Walks slowly and prefers to stay seated or lying down. Always moves as if they are exhausted and energy less
It is important to remember as stated above that all of these signs and symptoms are sustained over a long period of time and are not just present for a day or two.
They thus impact on the person’s ability to engage with everyday tasks and thus cope effectively within all areas of their life. It is common to see:
- Decline in work or school performance due to changes in cognitive They can also display an increase in absenteeism due to decreased energy and motivation.
- Conflict in relationships due to isolation when depressed often leads to family and friends feeling rejected by the Social disinhibition when manic can appear as a change in the individual’s morals and values which can be very disturbing for family and friends. How a person engages socially when they are in a manic state can often be completely out of character and thus confusing for family and friends. Because the person who is manic is unable to read the social cues and is unaware of how their behaviour affects others they are unable to respond appropriately to how what they say and what they are doing is affecting the people around them which then can make it humiliating for everyone and contributes to the conflict in relationships.
- Change in routine due to sleep patterns changing that can disrupt the family and the functioning of the home. Someone can be sleeping more when they are depressed and appear like they are lazy or avoiding responsibilities, or they can be extremely energetic and driven when manic that can then be very disruptive and irritating for the family as it feels selfish and inconsiderate.
- Interests can also change and how an individual dresses or engages with their hygiene routine can also be different. This can also affect the people around them as their dress sense can be very inappropriate for the occasion when they are manic and can be provocative or suggestive. Once again the person who is manic is unable to exercise effective judgement and thus is unable to register their inappropriateness and therefore can be resistant to the suggestions to change. A person who is depressed is going to lack the motivation necessary to engage in their normal hygiene routine and can appear disheveled and even a little dirty and unkept to the people around This again can be mistaken for laziness and thus again it can be seen how Bipolar impacts on the individual’s life, their integrity amongst their social group and their ability to function at work, at home and in their relationships.
What do I do if I think I have Bipolar?
If any of the above signs and symptoms feel relevant to you or someone close to you it is necessary to consult a psychiatrist as soon as possible. You can access very effective assistance and treatment in both the public and private sector. Some of the contact numbers are listed below.
- Helen Joseph Hospital: 011 4891011
- Charlotte Maxeke Johannesburg General Hospital: 011 4884911
- Laratong Hospital: 011 411 3500
- Akeso Clinic Group: 0861 HELP US (4357 87) or Akeso Randburg: 087 098 0457
- Life Hospital Group (Contact the closest Life Hospital)
- Any Emergency Medical Service or your closest Emergency Room
How is Bipolar Treated?
Once a diagnosis of Bipolar is made the appropriate medication will be prescribed. It is very important that the individual and their friends and family remain committed to treatment as non-compliance to medication is one of the leading causes of relapse.
We need to consider medication for Bipolar as we consider the need for insulin in a person suffering from diabetes. Mood stabilizers prescribed not only realign the chemical imbalance in the brain that is causing the mood disturbances but retains this balance.
It is necessary to take your medication every day to maintain the chemical balance and thus to retain a stable mood. We need to remember the impact on the individual’s life and the friends and family around them if their mood is not stable.
It prevents them from maintaining a quality of life and achieving their developmental milestones and effective baseline level of functioning. It thus needs to be the commitment of the individual and their support network to stay on the medication.
The biggest misconception made within the community is that the medication is addictive and the side effects are harmful.
Psychiatric medication is not addictive and with increased research and development, psychiatric medication is growing in its sophistication and ability to treat psychiatric illnesses.
Because psychiatry is a relatively new field of medicine, the misconceptions of psychiatric medication are borrowed from our past when medication was less effective, had severe side effects, and we had to resort to sedation to contain patients.
The amount of medications available to the psychiatrists today are vast and with fewer side effects. If an individual does not respond well to medication, they need to be encouraged to express their concerns and discomfort with their doctor so that these needs can be considered.
Psychiatrists have a lot more options at their disposal and so the stigma and fear to be on psychiatric medication should be stopped. We would never ask anyone to stop their heart medication or insulin, as the consequences to this are clearly understood and supported by the community.
Equal understanding and support is needed with regards to psychiatric medication as the harm that can result in the individual’s life from stopping medication should be seen as an equal risk as it would be to someone having a heart attack if they stop their cardiac treatment.
Therefore, an individual’s ability to accept their diagnosis and support from their friends and family increases their ability to manage their illness. Bipolar may not be cured, but it can be managed and a person can live a healthy, happy, successful and balanced life and achieve all the milestones as someone who does not suffer from BMD.
If an individual and their support structure accepts their diagnosis they are more likely to access help, stay on their medication, remain sober and substance free, access psychological help that will assist in psychoeducation, resolution of psychological issues, effective stress management techniques and establishing a healthy and balanced lifestyle.
All of this is essential to reducing the possibility of relapse. – Sarah Lamont – Therapeutic Manager & Occupational Therapist @ Akeso Crescent Clinic.
Where to get help….
- Akeso Crescent Clinic – 087 098 0457, s@akeso.co.za
- Akeso Psychiatric Intervention Unit 24 hrs – 0861 435 787
- SADAG help line: 0800205 076
- Schizophrenia and Bipolar Disorder Alliance: 011 463 9901
- Pretoria (Tswane) Bipolar Association: 012 348 6057
- Johannesburg Bipolar Association: bipolar@urbanblue.net
- Randburg Bipolar Family Support Group: skennedy@multichoice.co.za
This article was supplied by Akeso Crescent Clinic Randburg.
Details: www.akeso.co.za
