Causes, symptoms and treatments for manic depression. Manic-depressive psychosis: symptoms and signs

Many years have passed since Russia switched to the WHO criteria reflected in the tenth revision of the ICD. The International Classifier does not contain many formulations familiar to doctors with extensive experience, and diagnosis is recommended to be made on the basis of certain criteria, some of which are not entirely familiar to specialists from the CIS countries. Thus, our people, who do not take a taxi to the bakery, are surprised to realize that “vegetative-vascular dystonia” not only does not exist at the level of formulations, but does not exist at all in Western medicine. This is a common diagnosis, but only for the republics of the former USSR and some countries of the former socialist bloc. In Europe it is not just called differently, the nosological unit itself is simply absent there. There is F45.3 somatoform dysfunction of the autonomic nervous system, but the approach to the problem is completely different, completely different from what was popular in the USSR and continues to be found in psychoneurology in Russia.

Manic-depressive psychosis today is more often called bipolar affective disorder

Some completely psychotic disorders are excluded on a fundamental level, for example, “sluggish” schizophrenia. There are also those that have been renamed, but the essence of the approach to them has not changed. This is bipolar affective disorder. Previously, before the transition to the ICD, it was called “ affective insanity", and this name was used not only in the USSR and Russia in the 90s, but also in many countries around the world. However, by the end of the 20th century, more and more experts pointed to the stigmatizing impact of the term itself. In addition, a negative attitude arose towards the use of the very concept of “psychosis” in diagnosis.

Let's start with the fact that bipolar affective disorder, in the old way - manic-depressive psychosis, has symptoms and signs related primarily to the state of mood, affect, and this makes a direct indication of the presence of a psychotic factor in all cases doubtful.

The whole point is that the term was “crooked”, no matter what the supporters of the times of the primacy of the concepts of Academician Snezhnevsky thought about it.

In bipolar disorder, psychotic symptoms may or may not be present. And even if they do occur, they do not occupy a dominant role in the overall picture of the disorder by definition. Therefore, the gradation adopted in the modern ICD seems to the author to be the most correct, as is the terminology. The term “psychosis” is not always applicable to this disorder, and it is better to never use it at all to avoid confusion. What you probably already guessed is schizophrenia spectrum disorders, which are also related to affect.

Manic-depressive psychosis: symptoms

The syndrome as such does not have them, except for the changing phases of depression and hypomania. They can replace each other without a “bright” interval, or with the onset of interphase, mixed states are also possible with a variety of forms of the presence of depression within mania or vice versa.

Depressive episode

It differs slightly in its main features from a common mood disorder. During manic-depressive psychosis, it is expressed more in slower thinking and motor activity and decline in mood. Patients may have thoughts of suicide, but, fortunately, they are not so often put into practice, precisely because people are inhibited. In general, bipolar disorder is most often expressed by the depressive phase and usually begins with it. At the same time, depression grows in waves and has several stages of its development.

First, the physical tone changes - a loss of strength occurs, difficulties with falling asleep appear.
At the next stage, signs of decline in mood appear, anxiety arises, and motor retardation appears.
During severe depression, there is a clear decrease in physical activity, speech becomes slow, quiet and laconic. Patients can remain in one position for a long time - sitting or lying without moving. This is what is called depressive stupor. The difference from others, for example, from catatonic, is that a change in muscle tone is not visible. The muscles are not tense, and the sensitivity of the body is not lost. A depressed mood takes on the characteristics of hypothymia. Suicide attempts occur precisely at this stage.
The stage of severe depression is replaced by a reactive one, and during its course a reduction in all symptoms is noticeable. Often people become talkative and try to actively do something.

A little more detail about the stage of severe depression. It can be mild, medium and severe. In severe cases, sometimes psychotic symptoms are also observed. Most often, these are voices that “help” patients lose faith in the meaning of existence and push them towards suicide. These voices can be true or pseudo-hallucinations. The latter represents a thought that the patient seems to hear as a voice, or maybe it is not a voice, but a thought. They themselves cannot clearly correlate the phenomenon with some outside voice - they are not sure what it was.

It is actually difficult to express the state in words. Normal thinking is inhibited, but this does not mean that mentalism cannot arise when the flow of thoughts accelerates and cannot be dealt with. Mentism is similar to the condition that people experience when taking certain drugs. Each previous thought “pulls out” the next one, and the illusion arises that this painful state will never stop at all, and the thoughts not only seem alien, but in fact are completely uncontrollable for the patient, going in some kind of parallel flow with his consciousness.

However, all this does not provide grounds for making a diagnosis of “schizophrenia”, since it is only included in the overall picture, but is not the dominant element in it.

There is also delirium. In the vast majority of cases, it is associated with one’s own body and possible diseases. People really feel bad, and this is not surprising. They lose their appetite, and all food seems tasteless - somehow insipid and grass-like. Variants of atypical depression are possible when they eat a lot, but more often anorexia nervosa, a psychogenic loss of appetite, begins. It is not surprising that people are reeling; the possible exacerbation of some chronic diseases is also quite understandable. But they give it weird interpretations. Thus, hypochondriacal depression and depression with Cotard's syndrome arise. This is delusional depression in which patients believe that they are not just sick with something fantastic, but that this something can cause serious damage to others and to all of humanity in general.

Here we need to make one important remark. What do you think will happen to a patient if he comes to a local psychiatrist or hospital and openly tells that his organs have dried up, disappeared, stuck together, turned over, spread out and all this is very contagious? There are two options.

First. If the patient sticks to mild formulations, actively complains about his melancholy, loss of strength, and adds that sometimes even such strange thoughts come to mind, then a diagnosis of “F31.5 bipolar affective disorder, current episode of severe depression with psychotic symptoms” cannot be ruled out. . The formulation “severe depressive episode with psychotic symptoms” is also possible, since diagnosing bipolar disorder requires at least one manic or hypomanic stage, but at the time of the first diagnosis this may not yet have occurred.
Second. The patient is sure that he needs to be hospitalized because he poses a potential danger. He says that he has long lost hope in doctors, that they are not able to understand how difficult it is to endure. This means that the organs have stuck together or the stench is spreading in the form of a virus... It is not even excluded that the diagnosis of “paranoid schizophrenia” will appear in the medical history. Maybe not right away, but things are moving in that direction.

There is no need to think that psychiatrists just want to find a new patient with schizophrenia, and have no other concerns. The fact is that the loss of criticism and confidence in one’s deplorable somatic situation almost never manifests itself alone. If you talk for about thirty minutes, you can learn a lot of interesting things not only about the voices, but also their interpretation, and the voices themselves may be accompanied by something else. Negative symptoms will also be present and it will not be difficult to substantiate the diagnosis.

A depressive episode is a typical stage of bipolar affective disorder

Now let's think about what is the likelihood of losing criticism? Maybe 10% of patients in this case understand that such diseases do not happen, that organs dry up and disappear, or that some other miracles occur. They themselves assess their condition as absurd fantasies that come to mind. The rest tend to persist. And in the combination of all the signs, the picture will tilt towards schizophrenia. Therefore, there is nothing left but to make a more significant diagnosis.

Thus, the same Cotard syndrome can speak of both delusional depression and paranoid schizophrenia. It depends on how many criteria you can count.

Manic episode

This is further confirmation that “manic-depressive psychosis” is a misleading term. Mania itself is quite rare; hypomania, or a state of “mania in miniature,” is more common. The full manic phase includes five stages.

Hypomania- an increase in mood, activity, performance, and a surge of strength.
Severe mania- continuous activity, laughter, jokes, activity, talkativeness.
Fury Stage- speech is incoherent, activity is chaotic.
Motor sedation. At the same time, the rise in mood and talkativeness continues.
Reactive stage- the emotional sphere returns to normal, there is even a slight decrease in mental activity.

However, such a serious picture is not always observed. More often, the development of the stage does not go beyond the hypomanic stage, and all other signs are only slightly visible in it. The severe form may also be accompanied by psychotic symptoms.

Manic-depressive psychosis, what is it from the point of view of the patient?

It should be noted that the old term was strongly associated with a misconception about who patients are. He involuntarily pushes to the idea that this is some kind of Raskolnikov type - a kind of sick man with long hair, an ax in his hands, who only does what he does: send old women and unwary young girls to the next world. The disorder, like love, is subject to all social groups; it occurs in both men and women. Age can also be different - from 15, in rare cases, years to the elderly. But more often these are women from 25 to 60 or more years old. In terms of danger, they present it more to themselves. The main one is suicide, although anorexia nervosa, as well as uncontrolled activity, does not bring anything good.

Mixed and fast cycles

The symptoms of manic-depressive psychosis as such are not that difficult to detect. It is much more difficult to determine the characteristics of the current episode. The fact is that they can be of a mixed nature.

A manic episode is usually characterized by inappropriate behavior

Main triad:

mood,
physical activity,
thinking

may include opposite signs. For example, the mood is in decline, but the person is active and his thinking seems to have accelerated to the limit. This results in agitated depression, anxious depression and depression with racing ideas. Let us also add here that it is possible that more than four separate episodes of mania, hypomania or depression may occur during the course of a year. They can be separated by “light” intervals, or they can follow continuously one after another, while the mood changes sharply, even within one or two days, to the opposite. There are also ultra-fast cycles - these are several episodes within one month.

Another diagnostic difficulty is the appearance of symptoms of the hypomanic phase due to the use of antidepressants.

Manic-depressive psychosis: causes

The situation here is very interesting. Everything that has obvious external causes needs to be eliminated during differentiation. However, what is of an endogenous nature is also eliminated.

What is manic-depressive psychosis in terms of a differentiated diagnosis?

What needs to be excluded?

Unipolar depression, a depressive episode in itself, according to ICD-10 F However, in the USA it has become possible to classify individual depressive episodes as bipolar disorder. As a result, the number of diagnoses immediately increased.
Personality disorders, which is understandable. Can a certain type of person, who is in a distrustful, selective state and by nature teetering on the brink of depression, also suffer from bipolar affective disorder? Yes, of course... Who would suffer from it otherwise? As a result, we get two layers of non-standard affect, like signs of bipolar disorder and signs of personality disorder.
Schizophrenia. We already wrote above that patients with schizophrenia and bipolar disorder can become delirious. Only in the first case the symptom complex will be much more complex.
Substance abuse. Everything is also clear and understandable, but so far it has not come to practice. Let's say someone used drugs and it's been a year since they stopped doing it. Now he is showing signs of manic-depressive psychosis. And what is this - a consequence of drug use or a disorder in itself? Of course, the latter... But how can we be sure that he definitely did not use anything this year?
Affective disorders with somatic or neurological causes. To exclude them with complete confidence, we must conduct an extensive study of the state of the brain and the entire nervous system. This is a long and sometimes expensive process. Therefore, it should not be surprising that all this exclusion occurs according to the patient. He may not even suspect that he has some kind of tumor in the brain. Manic-depressive psychosis may outwardly resemble a condition caused by hypoglycemia, but of course this must be excluded, which means a comprehensive examination of the somatic status is necessary.

It is also necessary to exclude neuroses, infectious, psychogenic, toxic, traumatic psychoses and mental retardation. In other words, everything is different. But only some disorders have the ability to be combined into one picture of the pathogenesis of a particular patient. It is sometimes impossible to exclude all possible psychoses and neuroses.

Drugs may cause manic-depressive disorder

However, after ruling out what can be ruled out, what remains is manic depression. No one knows what it is in terms of its causes, as well as about unipolar depression, as well as about all serious mental disorders in general and mood disorders in particular. Therefore, by the way, one should not wonder whether manic-depressive psychosis is inherited. The correct answer is: both yes and no.

Manic-depressive psychosis: treatment

We do not set ourselves the goal of writing a detailed textbook of practical psychiatry. Therefore, let's start with the difficulties that the treatment of manic-depressive psychosis causes. Usually they try to immediately prescribe a loading dose of certain medications. In this way, psychiatrists bypass the possibility of the disorder becoming resistant to a particular drug. Not only are large doses prescribed immediately, but they are also increased until the most suitable regimen for the patient is developed. In this case, it is necessary to exclude situations when two drugs of the same group are used. For example, two antipsychotics.

Lithium preparations and antiepileptic drugs such as valproate, carbamazepine and lamotrigine are used. Some experts consider the justification for using lithium preparations to be controversial. Others claim that they have been statistically proven to reduce the number of suicides among patients. We would like to make a clarification. Valproate and carbamazepine may be effective in a manic episode, but are completely useless in a depressive episode.

So, the promised difficulties... Deliberately increased doses of any drugs too often provoke an inversion and patients fall from one affective pathological state to another. The same problem unfolds against the backdrop of the fact that episodes, especially those that often replace each other at high speed, turn out to be resistant to therapy.

In general, such patients, during periods when the phases reach their maximum, would be good to show to two groups of people. People with increased suspiciousness and a tendency to hospitalism, who may come and tell doctors that they are having a moderate depressive episode, and therefore need enhanced treatment, as well as those who think that patients simply let something on themselves. They don't know how to control themselves. When a patient jabbers something, and then generally switches to individual sounds, but has already forgotten what he wanted to say and therefore says something else, he definitely cannot control himself. Well, he won’t be able to control himself. He may not be able to keep his hands still. So it’s very difficult for him to control himself.

It wouldn't hurt to look at a typical unipolar major depressive episode either. This doesn’t happen very often, but the stupor looks so good that it’s time to wonder if it’s catatonic schizophrenia. Mood disorders can be extremely serious and create a total decrease in the quality of life of patients.

And here's another observation. Often there is an impression that the disorder occurs somewhere in a parallel world. You will inevitably become a mystic and occultist. Let's assume that somewhere, in another dimension, there actually exist those bodies that in magic are called etheric, astral, energetic, and so on. The whole drama of pathogenesis unfolds there, and here we see a guy who sits with a stony face and speaks in a whisper, or a 45-year-old lady who continuously repeats something, but ask her to retell what she just said and she won’t be able to, but compensates with a new story about something else. Just as quickly and incomprehensibly... It’s quite difficult to say all this now. Of course, the author will immediately appear as a naive person who allowed himself to show signs of magical thinking. But how do we know now what science will be like in 100 years? Maybe then all bodies and other worlds will become the same scientific reality as the world of atoms is now real.

All we can do is influence the effects a little, without understanding any reason at all. Pay attention to the enthusiasm with which we are introducing the practice of searching for gene and chromosomal abnormalities as the cause of mental disorders. At the same time, all attempts come up against a certain limit and remain hypotheses of the origin of disorders, which have arguments “for”, but also arguments “against”.

Attempts at pharmacological therapy for manic-depressive psychosis are not so far removed from attempts at treatment with folk remedies. As mentioned above, the depressive phase is the longest and most often manifests itself. However, there is no clear and obvious understanding of whether antidepressants are needed in this case or whether they will only aggravate general emotional instability. How does everything really happen? The first episodes usually go unnoticed, or people turn to psychotherapists with depression. If the first episode is hypomanic, the future patient may even enjoy it. He is active, boldly takes on a variety of projects, brings many to completion and is a tireless person. The problem begins when symptoms begin to increase. Either hypomania turns into mania, or it goes into depression with anxiety, or distorted affectivity is a mixed stage. But in this condition, treatment gives a stable remission much less often than when turning to specialists already during the first episode.

There is no such thing as chronic manic-depressive psychosis. In essence, any disorder is long-term, and treatment is a long-term process that in one form or another can last a lifetime.

Sometimes manic-depressive psychosis must be treated throughout life

Manic-depressive psychosis, what is it in terms of prognosis? The situation can develop in any way - from assignment of disability group I to treatment of an acute form at home on a sick leave. A forensic psychiatric examination recognizes patients as insane if they committed some kind of illegal act at the time of the episode and as sane if there was an intermission at that time, but identifying this is an extremely difficult task.

Manic depression is a mental illness that is characterized by constant changes in a person’s mood: from severe depression to incredible elation and hyperactivity.

With manic depression, a person cannot control his emotions. People with this disease are very shy and quiet in everyday life. Sometimes their behavior has elements of fanaticism or religiosity. In many patients, depressive phases recur more often and last longer than mania. The prevalence of this disease is the same among men and women. Women are more likely to develop a depressive phase than a manic phase.

The patient's mood changes can occur over the course of a week, a month or even a year. During the “bright” period of the disease, the person is calm and balanced; general weakness and drowsiness may be observed.

The severity of symptoms of mania or depression varies from patient to patient.

Symptoms of manic depression are first observed in patients under 35 years of age. If this disease debuts in childhood, it is accompanied by attention deficit hyperactivity disorder. A person’s psychotype plays a major role in the development of the disease. Most often, manic depression is observed in individuals with a psychasthenic and cycloid personality.

Causes

Genetic predisposition. Most often it occurs in people whose relatives suffered from various mental illnesses: epilepsy, schizophrenia, depression;
Biochemical disorders in the brain. Depressive symptoms are caused by low serotonin production;
Hormonal changes. Most often, signs of the disease are caused by a sharp decrease in estrogen levels or disruption of the thyroid gland. Changes in mood phases most often occur in women during the premenstrual and menopausal periods, during pregnancy, after childbirth;
Acute and chronic stress;
Injuries;
Infectious lesions of the brain.

Symptoms

Manic depression is characterized by seasonality in the manifestation of symptoms - spring and autumn. At the very beginning of the disease, a person experiences a mild change in mood.

Manic phase of the disease

This phase of the disease manifests itself in the form of symptoms of elevated mood and hyperactivity.
A person unexpectedly experiences a feeling of happiness and well-being. It seems to the patient that he loves the whole world. He is excited, his eyes are “burning.” A person feels an extraordinary surge of strength - physical and moral. The patient is optimistic about the future and believes that he can handle all problems. He makes grandiose plans in his head, sets himself big and sometimes impossible tasks. At this moment, a person is capable of committing many rash actions: quitting a new job, divorcing a spouse, moving to another city. A person removes all internal “clamps” and complexes from himself and begins an active sex life with a new partner.

Increased activity and talkativeness leads to the fact that a person makes new acquaintances.

During this phase of the disease, some patients discover unusual talents and inventions. The patient talks a lot, sings, and is very active. Sometimes he himself admits that his tongue cannot keep up with his thoughts.

In the manic phase of the disease, a person speaks quickly and cannot concentrate on small things. He's fussy. The patient exhibits excessive importunity and intolerance towards other people.

Manic depression manifests itself in the form of increased impulsiveness of a person, which sometimes leads to scandals with loved ones and relatives. It seems to him that everyone underestimates his capabilities and does not understand his plans. He takes on several tasks at the same time, but does not complete any of them.

During this period, patients are prone to drinking alcohol and drugs. A person is constantly in a hurry to get somewhere, and his need for sleep and food decreases. During this period of the disease, the patient does not feel danger, is not careful in his actions and actions, which can lead to trauma.

Some patients begin to actively engage in a healthy lifestyle, run in the morning, and douse themselves with cold water. A person in a manic phase believes that he must develop himself, learn to sing, draw, dance. Patients begin to actively attend clubs, sections, and personal growth groups. Some patients try to “infect” other people with their positive attitude, trying to find like-minded people in their plans and ideas.
The patient's speech is loud and expressive. He is humorous, feels like an erudite, but his judgments are superficial. During this period, patients can suddenly change their image, start dressing brightly and wearing makeup, and visiting entertainment venues.

A patient in a manic phase has a positive attitude towards life. It seems to him that he is starting his new life, which is very different from the past, that he is “a completely different person.”

The emotional upsurge of the patient is accompanied by incorrect judgments and conclusions. A person discovers unusual abilities. He hears and sees only what he considers necessary for himself. Some patients consider themselves God-like.

Depressive phase of the disease

The person is in a low mood. He feels sad and weak. It seems to him that his life has no meaning. He spends all day at home, does not communicate with people. Women cry, remembering their past life; they cannot find anything good in it. They are pessimistic about the future.

For such patients, slow mental reactions and movements become characteristic. Some patients begin to blame the people around them for their “unsuccessful” life. Some patients have thoughts of suicide.

The patient shows complete indifference to all activities. During this period, many people experience a feeling of helplessness and hopelessness. The person is irritable, confused in his thoughts, and cannot concentrate on small things. He has a great need for sleep and rest. The patient feels that he is very physically and mentally tired.

During this period, many women have a depressed mood accompanied by an increased appetite, they eat a lot of sweets and starchy foods, and gain a lot of weight.

Some patients suffer from anorexia during the depressive phase of the disease.

At night, patients cannot sleep. Sleep is superficial, with nightmares. The patient exhibits signs of increased anxiety. He constantly worries about the life and health of his loved ones.

The face of such patients is tense, their eyes do not blink.

In many patients during this period the disease There are complaints about somatic pathology: arrhythmia, angina pectoris, stomach pain, constipation. Women may experience menstrual irregularities. Life appears to a person in a “gray” color. He does not smile, is not talkative, and is completely immersed in his inner experiences.

Some patients may fall into a state of stupor and sit and stare at one point for hours. There is another extreme of this disease, when the patient begins to rush around the apartment, cry, scream, and ask for help. At this moment he is capable of rash actions and suicide.

Diagnostics

Very often, patients themselves cannot adequately assess the degree of manifestation of symptoms of manic depression. A sharp change in mood is usually noticed by the patient’s relatives, who advise him to consult a psychologist or psychiatrist. In order to correctly diagnose a patient, it is necessary to keep a diary of his psycho-emotional state. Women need to consult a gynecologist and endocrinologist. Before starting treatment, some patients need to have their blood tested for thyroid hormones and estrogens and conduct an ultrasound examination.

Therapy

The patient is prescribed complex treatment, which includes medicinal and non-medicinal methods. When prescribing psychotropic drugs, it is necessary to exclude the use of alcohol and narcotic substances in patients.

Treatment of symptoms of manic depression depends on the age of the patient, concomitant pathologies, and the severity of the phases of the disease.

Patients are prescribed psychotherapy and medication. During the depressive phase of the disease, a person is prescribed sleeping pills, sedatives, and antidepressants. During the manic phase, the use of normomitics (valproate) and lithium preparations is indicated.

Antipsychotic drugs help eliminate agitation in the patient.

If the signs of manic depression are caused by hormonal disorders, then they are corrected with medication by an endocrinologist. Treatment with psychotropic drugs is not indicated for pregnant women and in the postpartum period; herbal sedatives are used. At the time of hormonal changes in the female body (menstruation, menopause, pregnancy), it is necessary to adhere to a sleep and rest regime. Women are recommended to exercise moderately (morning exercises, yoga, swimming) and walks in the fresh air.

Benzodiazepines are good at relieving symptoms of the manic phase of the disease. The main treatments prescribed are lorazepam and clonazepam. Benzodiazepines relieve the patient's insomnia, agitation and anxiety.

For manic depression, anticonvulsants are prescribed - carmazepine and depakine. Treatment is prescribed with minimal doses, then the dosage is gradually increased. The dose of the drug is adjusted according to the clinical picture of the disease, the number of remissions of mania and subdepression in the patient.

Given the duration of treatment for manic depression, it is necessary to monitor the side effects of pharmacological drugs and monitor the patient’s mental state.

With manic depression, the patient needs the support of loved ones. Some patients are prescribed medications in a minimal dose to prevent seasonal exacerbations of the disease.

Manic-depressive psychosis (or bipolar personality disorder) is a pathology of the human mental sphere, in which affective disorders are observed in the form of alternating manic syndrome and depression. Interestingly, MDP in mild cases of the disease sometimes goes unnoticed, and its manifestations are often confused with other mental disorders. Isolated forms are less common, but if they are detected, then with a severe depressive episode, such patients are diagnosed with “endogenous depression.” And with manic syndrome, the diagnosis includes a wide range of mental disorders, which also includes schizophrenia. There is also a mixed form, which is characterized by rapid alternation of mania and depression; it is by this course of the disease that it is easy to identify true manic-depressive psychosis (circular psychosis).

It is much more difficult to understand whether MDP is an independent nosological entity or is a consequence of another mental disorder. We all have mood swings, a state of deep depression or explosive euphoria, but not all people have depressive-manic syndrome.

The causes of manic-depressive psychosis are varied. Moreover, unlike other mental disorders, MDP is not always associated with genetics, although in most cases it is inherited. Factors causing this disease include:

Personal characteristics. The so-called manic personality type: a person is confident in his own rightness, pedantic, responsible, and serious. Hypomanic: friendly, soft, vulnerable, sensitive, whiny. In other words, choleric and melancholic people are most susceptible to MDP;
Manic-depressive syndrome as a consequence of another mental disorder;
Burdened heredity;
Economic and social disadvantage;
Stress (physical or mental abuse, strict upbringing);
Trauma to the skull and head.

Prevalence

This disorder most often occurs in women due to specific character traits and hormonal instability. According to the latest statistics, we can conclude that the female half of the population has 1.5 times more cases of TMD than men. The risk of getting sick increases if a woman is under severe stress or is in the postpartum or premenopausal period. The peak of the disease usually occurs between 20 and 30 years of age, which also makes early diagnosis difficult. By the end of the 20th century, the number of people with MDP reached 1%, and of these, 0.3% had a severe form.

In adolescents, MDP develops unnoticed; the symptoms are mistakenly accepted by others and parents as a manifestation of character (depression, reluctance to communicate with anyone, or, on the contrary, motor and speech agitation, aggressiveness).

Classification of manic-depressive psychosis

Depending on the predominance of one or another affective symptom, MDP is distinguished:

Unipolar. With this form, a person only experiences:

Periodic mania;

Periodic depression.

Bipolar. These two symptoms alternate.

True bipolar personality disorder has 4 forms of possible course of the disease:

Properly interspersed. Depression and mania alternate with each other, and there are light intervals between episodes;
Incorrectly interspersed. The alternation of these two symptoms is chaotic, sometimes several depressive episodes are observed in a row at once, or vice versa, there are light intervals between attacks;
Double - mania is replaced by depression and represents one large episode; there is a clear gap before the next symptom complex;
Circular. The alternation of depression and mania is constant, but there are no clear intervals between attacks.

Each episode of manic-depressive psychosis can last from several days to several years, with an average phase duration of up to six months. The classic picture of MDP is a 3:1 ratio of depression to mania. The light period in the absence of symptoms can reach 7-8 years, however, it is often limited to only a few months.

Symptoms of manic-depressive psychosis

Clinical manifestations depend on the phase in which the patient with MDP is.

Hypomanic psychosis is characterized by increased vitality, improved thought processes, and increased physical activity. A person in this state walks “as if on springs”, enjoys insignificant little things, and the need for sleep decreases. This phenomenon is called tachypsychia. The hypomanic state lasts about 3-4 days.

Moderate mania is accompanied by dysphoria; a good mood is easily overshadowed by bad events, and then just as easily restored. With this form, social interaction with other people is difficult, the person becomes forgetful and absent-minded. The duration of moderate mania ranges from a week to several months.

Severe mania has more pronounced symptoms, and people in this state are often prone to violence. Sometimes delusions and hallucinations occur.

The depressive phase includes bradypsychia, which is a inhibition of thinking, a painful decrease in mood and a decrease in motor activity. Patients lose appetite, the need for sexual intimacy disappears, and an anxiety-phobic disorder develops. These symptoms are more pronounced in the morning, and gradually decrease in the evening (a characteristic feature for people with MDP, which will allow differential diagnosis with depression).

Types of depression in MDP

MDP depressive form is characterized by several types of depression:

Simple. Characterized by low mood, decreased physical and mental activity. That is, it represents the triad of classical depression;
Hypochondriacal. In addition to low mood, the patient experiences fear for his health and an anxiety-phobic disorder. Carcinophobia, the fear of cancer, is especially common;
Delusional. In addition to the classic triad, there is the presence of hallucinations and delusions. Often – depersonalization, in which a person looks at himself as if from the outside;
Agitated. Classic depressive symptoms alternate with excessive motor and speech arousal, increased anxiety, and a delusional disorder in the form of delusions of guilt is characteristic;
Anesthetic. Inability to feel anything, patients complain of “emptiness inside.”

The depressive symptom itself can be either with or without somatic manifestations. With the first option, patients may complain of headaches, discomfort in any part of the body, a feeling of a lump in the throat, difficulty breathing, heaviness in the chest.

All people with some type of depression are susceptible to suicide attempts, so it is necessary to carefully monitor them.

Diagnostics

Diagnosis of manic-depressive psychosis is based on the exclusion of another mental disorder or confirmation of true MDP.

The brain is examined to identify organic lesions (MRI) and/or distortion of the conduction of nerve impulses (EEG). It is advisable to have a conversation with relatives about the health of the sick person, since such patients often lack criticism of their condition.

In order to make a diagnosis of manic-depressive psychosis, at least two episodes of mood disturbance must be present. Moreover, one of them must be a manic syndrome. Correct interpretation of the clinical picture, comparison with risk factors, heredity, instrumental and laboratory research methods, and the patient undergoing a series of tests for bipolar personality disorder will allow the psychiatrist to make a correct diagnosis. It is imperative to differentiate MDP from depression, drug abuse, neurotic conditions, schizophrenia and other disorders that arise as a consequence of a neurological or other somatic disease.

Treatment

Severe forms of manic-depressive psychosis are treated exclusively in a psychiatric hospital. For mild or moderate forms, outpatient treatment is possible, provided the patient is adequate. Therapy differs depending on the phase of the disease. For depression - antidepressants and mood stabilizers. For manic syndrome – mood stabilizers. If MDP is severe, then antipsychotic drugs are used. Additionally, conversations are held with a psychotherapist and/or psychiatrist to determine the reason that led to the development of MDP. In children and adolescents, it is necessary to exclude juvenile schizophrenia and attention deficit hyperactivity disorder (a number of tests are carried out that will allow a correct diagnosis). During the depressive phase, occupational therapy and engaging in a favorite hobby are recommended. For manic symptoms – aromatherapy, acupuncture, massages. Treatment with folk remedies (ginseng, decoctions of mint, chamomile, etc.) has little effect on the patient’s condition and can only be carried out in combination with prescribed medications.

Prevention

To prevent the occurrence of MDP, it is necessary to isolate yourself from the effects of stress - not to get involved in conflicts, to avoid uncomfortable situations. If a person feels the approach of a depressive or manic phase, he should take medications prescribed by a doctor to smooth out the picture of MDP. When taking medications systematically, the risk of developing a new affective disorder is significantly reduced.

Forecast

During the interictal period, as a rule, there are no complaints, but, unfortunately, MDP is a chronic disease, and the goal of therapy is to create favorable conditions for lengthening the light intervals (achieving stable remission). With the circular form, people often become disabled, since the endless alternation of mania and depression without clear intervals greatly undermines the emotional state of the patient.

Every person has mood swings. These are normal ups and downs that we all go through from time to time. But if you suffer from manic depression, the mood swings may be extreme and the symptoms may be severe, but the condition is treatable. Today, manic depression is called. The term "bipolar" is used because a person with manic depression experiences moodiness that swings uncontrollably between two extremes, the "pole" of depression and the "pole" of emotional arousal.

Manic depression is a long-term illness that usually begins before the age of 25. The disease affects about three million adults in Russia, but can also develop in children. People with typical depression, or clinical depression as it's called, have similar symptoms, but they don't experience the highs that people with manic depression have.

General symptoms

Similar symptoms include:

Sadness for a long time
Crying for no reason
Feeling of worthlessness
Feeling very low energy
Loss of interest in enjoyable activities

Because some of the symptoms are similar, approximately 10 to 25 percent of people with manic depression are first diagnosed with clinical depression.

Distinctive symptoms

The "manic" symptoms of bipolar disorder, which make it distinct from clinical depression, include:

Feelings of extreme happiness, excitement, and confidence
Feelings of irritability, aggressiveness, and "tightness"
Uncontrollable thoughts or speech
Thinking of yourself as very important, gifted, or special
Poor judgment
Dangerous behavior

Children and adolescents with manic depression may display hyperactive behavior. Teenagers are prone to antisocial or socially dangerous behavior, accompanied by sex, alcohol or drugs. Unlike people with manic depression, those with manic depression are less likely to be able to engage in normal activities and are more likely to contemplate suicide.

Classification of bipolar disorders

Low periods of manic depression are sometimes referred to as "unipolar depression." High periods tend to be experienced less frequently than low periods, and people are more likely to seek help to get out of a low period. Types of manic depression include:

Bipolar I disorder. This term refers to manic depression, which includes high or mixed periods that last at least seven days or are extremely severe. Patients usually have depressive periods that last about two weeks.
Bipolar II disorder. In this type of manic depression, the person is depressed, but the high periods are less extreme.
Cyclothymic disorder. This term refers to a form of manic depression in which both high and low mood swings are milder than in other types of manic depression.

Manic Depression: Getting Help

If you have any symptoms of manic depression, the best thing you can do is see a doctor. Although there is no blood test or brain scan that can show whether you have manic depression. It is important that your doctor makes sure that your symptoms are not caused by other medical conditions. Other illnesses and health problems that often occur with manic depression include:

Alcohol or drug abuse
Post-traumatic stress
Hyperactivity
Thyroid diseases
Headache
Cardiovascular diseases
Diabetes

Whether it's manic depression or bipolar disorder, it's a lifelong condition. If you have bipolar disorder, you will need long-term treatment to help you control your mood swings. The good news is that a combination of psychotherapy and medication is usually effective.

Most importantly, know that manic depression is not a weakness of character - it is a treatable disease. If you think you might have manic depression, the first step is to get help.

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Mental illness manifests itself in severe agitation, or the occurrence of moral disorder. People with this type of illness are completely detached from reality and try to break through limitations. The concept of manic depression combines two components. This is a sharp change in phases of mood, and a rapid restructuring into different states. The concept of mania describes the agitation and elation of a person. Feelings give way to internal instability, and create the foundation for the development of depression and anxiety. Avoiding the consequences by consulting a doctor in a timely manner will allow you to carefully study the causes of the manifestation of this disease.

What factors influence the onset of manic depression?

Psychiatric research does not fully understand what causes this type of disorder. Most experts believe that genetic predisposition - stress and sudden changes in a person's life - have an influence. Approximate links between the causes of manic depression:

Chemical changes in the brain.
Sudden mood swings.
Negative situations that cause anger and rage in a person.
Constant nervous breakdowns.
Constant feeling of danger for yourself and loved ones.
Increasing sense of risk.
Lack of correct perception of the opinions of others.
Poor functioning of the motor complex.
The presence of other diseases associated with the human autonomic system.

Examinations are carried out regularly. This is due to the search for questions - how to avoid the first attack, and prevent a similar condition in the future. First of all, you should contact doctors such as a neurologist, psychiatrist, or psychologist.

How does manic depression manifest?

A characteristic feature of manic depression is rapid changes in mood in a chaotic sequence. In other words, there is a lack of specificity in the patient’s actions and thoughts. There is a situation where depression does not always occur after mania. A person experiences one attack, but then changes his mood in a different direction. A change in the phase of a person’s state is observed immediately or after a certain period of time. The severity of manic depression is manifested in conditions such as:

Maximum degree of optimism, joy and excitement.
Changing a happy image into an irritable and angry image.
Hyper-reactivity.
A quick conversation with the interlocutor, and the inability to grasp the essence of the conversation.
Increased energy and decreased need for sleep.
Sexual excitement.
The desire to win and complete difficult tasks.
High impulsiveness.
Nervous judgments, jumping from one extreme to another.

Bipolar disorder involves psychopathic episodes - seeing things that don't exist or believing that a person has psychic abilities. Features of symptoms that include manic depression:

Sadness.
Malaise.
Hopelessness.
Indifference.
Constant crying, and an attempt to evoke pity from the people around him.
Difficulties in making decisions.
Lack of sleep.
Irritation to reality.
Suicidal thoughts.

Manic depression is a dangerous manifestation of mental and negative behavior that negatively affects the people around you.

Who is most likely to experience manic depression?

Statistics show that the disease can affect people under the age of 35. Here, there is a sharp transition from a normal state to an excited mood, and vice versa. There are several groups of people who are susceptible to developing a complex degree of the disease:

Young children aged 6 to 11 years may find themselves in a situation where the disease is in its early stages. If treatment is not carried out in time, the disorder will reach the stage of manic acute depression.
The second category susceptible to “mania” is women; the sensitivity of the weaker sex allows the disease to develop at a high speed. Girls are more susceptible to manic depression, this is often due to a passive mood and laziness - even removing hair dye at home is sometimes very difficult for them. Another influential factor is hormonal imbalance, which is caused by taking antidepressants in large quantities.
Men are least affected by bipolar disorder, but when the disease occurs, it is due to drug or alcohol addiction.

Manic depression can occur in people who have a mood disorder or have post-traumatic stress disorder.

How is manic depression diagnosed?

It is impossible to check whether a person is sick or not without a preliminary examination. This means that it is necessary to go to the hospital if symptoms of manic depression are observed - sudden changes in mood, restlessness and inability to adequately perceive information. Basic human actions:

See a doctor (if suspicions are confirmed by certain signs). As a rule, you can monitor your behavior with the help of friends or relatives, who will record shortcomings in your mood and physical condition.
Carrying out the necessary tests to check the mental and physical condition of the suspected patient.

The initial stage of bipolar disorder involves treating the patient with special medications and conducting psychotherapy sessions.

What are the most popular types of bipolar disorders?

Manic depression includes several types. Classification depends on the degree of the disease:

The disorder of the first group is characterized by high or mixed changes. The duration of mania is up to 7 days.
Depression of the second category consists of low changes in mood, and does not involve strong arousal during attacks.
Cyclothymic disease involves the occurrence of low and high mood swings, which are accompanied by mild and consistent changes.

Disease categories provide the correct course of treatment in the future. Studying the characteristics of the disorder makes it possible to enhance the therapeutic effect and prevent the occurrence of acute bipolar disorders. Severe cases of manic depression appear in two positions:

Numbness is characterized by indifference and lack of understanding of what is happening in reality.
Loss of control over behavior. This condition manifests itself in severe agitation and nervousness. A person does not feel a sense of boundaries, rushes about, and refuses the help of loved ones.

The onset of loss of control requires immediate hospitalization of the patient and the appointment of a course of treatment.

What symptoms are characteristic of the phases of bipolar disorder?

What is manic depression? The effects of mental illness are accompanied by changes in mood. There are specific stages for each component of manic depression. The manic phase differs from depressive psychosis by motor factors (sharpness, movement without stopping, a feeling of some euphoria). The manic phase occurs in stages:

Hypomanic syndrome includes spiritual uplift and mental alertness.
Severe mania is caused by the discovery of nervousness.
Manic frenzy is accompanied by a maximum degree of irritation.
Motor sedation is due to reduction signs of excitement.
The reactive stage involves the stabilization of all the prerequisites for mania.

Another root of problematic health is the depressive phase. Basic moments:

Depressed mood, and decreased mental and physical performance.
Depression increases, including inhibition of the motor system and mental deviations from the norm.
The pronounced stage of the disorder combines all the symptoms into one whole.
Presence of asthenia or hypertemia, each of the situations manifests itself according to characteristic signs - drowsiness or increased motor activity.

What medications are there to treat manic depression?

Forms of treatment for manic depression are presented as medications. Medicines are relevant for people with the initial stage of the disorder, and patients who are in a state of strong feelings.

Lithium – used to stabilize mood and normalize behavioral changes in a person. The drug reduces the symptoms of mania, but requires regular use. Typically, the rehabilitation period lasts from two weeks to several months. Doctors recommend following safety rules, as the drug has side effects:

Weight gain.
Malaise.
Vomit.
Frequent urination.

The medicine greatly affects the functioning of the thyroid gland and kidneys; while taking it, medical supervision is required. If symptoms of lithium overdose appear during the course, you should go to the hospital. Main reasons:

Visual impairment.
Arrhythmia.
Presence of a cramp.
Difficulty breathing.

The next option is depakote. The drug prevents seizures and is used during the treatment of bipolar disorder. A drug overdose includes side effects:

Indifference.
Diarrhea.
Spasms.
Weight gain.
Slight trembling in hands.

Patients with manic depression usually take more than one type of medication. The process is due to the restoration of feelings and stabilization of mood. The treatment course should include anti-mania medications and antidepressants. Separately, they include: Aminazine, Pipolfen, Tizercin, Haloperidol, Amitriptyline and Finlepsin. Important: practice shows that combining two different drugs will create conditions for a quick recovery.

What are the consequences after the course of treatment?

Prompt treatment prevents new symptoms of bipolar disorder. But, in severe cases, when the patient suffers from alcohol and drug addiction, a course of repeated rehabilitation is necessary. The results of “undertreatment” can be:

Change in appetite.
Disorders of the musculoskeletal system.
Insomnia.
Withdrawal from society.
Dangerous human behavior.
Proposing ridiculous ideas regarding life values.
Conversations about death.
Increased sensitivity.

It should be remembered that patients with manic depression, even after recovery, are in a less protected state. What do doctors recommend? How to prevent bipolar disorder? The method includes help and support from others. Simple techniques to calm and stabilize your mood:

Lifestyle changes.
Healthy eating.
Conducting technical relaxation.
Taking water procedures.
Elimination of negative thinking patterns.

A person’s psychological and physical actions depend on external factors, so you should surround yourself with only positive values as much as possible. More communication, joyful meetings and comprehensive relaxation will help you avoid bipolar disorder.