Tuesday, 1 May 2018

Bipolar And Unipolar Disorder: Co-morbidity, Prognosis, Factors And Treatment

May 01, 2018
The Co-morbidity is common for both Polar and Unipolar disorders. Some common co-morbid psychiatric disorders include Anxiety disorder, alcohol/substance misuse, personality disorders, eating disorders, ADHD. 

Whereas, Physical co-morbidities include: Thyroid dysfunction, migraine, metabolic syndrome (induced by antipsychotics).
Bipolar and unipolar depression :Signs and Symptoms and treatment


Prognosis Of Mood Disorders- Poor Prognostic Factors

  •  Earlier age of onset(childhood-onset Bipolar).

  • Longer duration/increased severity of episodes.

  • Poor initial response to treatment.

  • Suicidal behavior.

  • Alcohol and substance misuse.

  • Low level of social support/ social integration.

Additionally increased frequency of episodes, Psychotic symptoms, mixed episodes, family factors such as high expressed emotions, and the first episode of depression rather than Mania are some poor prognostic factors for the Bipolar disorder.



Treatment of Depression (Bipolar And Unipolar Disorder)-



There are two main treatment approaches for depression, which is  used either on their own or in combination:
  1. Anti-depressants

  1. Psychotherapy (usually CBT-Cognitive Behaviour Therapy)

Rationale For Anti- Depressants-

Monoamine Hypothesis of Depression: This states that depression is due to a deficiency of Monoamines(Serotonin or Noradrenaline) in the brain so, by increasing the levels of one or both of these monoamines, depression can be treated.


Newer Antidepressant :

1) Agomelatine:
  • Agonist at MT1/MT2 melatonin receptors.
  • Melatonin, secreted by the pineal gland (which is important to sleep).
  • MT1 and MT2 receptors are located in the suprachiasmatic nucleus of the hypothalamus(the sleep center).
  • Common side effects include diarrhea, headache, and nausea.


General Principles When using Antidepressants.

  • Start Low, Go Slow

    •          Start at a low dose.

    •          Increase dose gradually(if needed).

    • Review mental state regularly.

    • Monitor for side effects.

    • Avoid 'poly-pharmacy'(using more than one antidepressant, except for treatment-resistant Depression)

NOTE- It usually takes at least 2 to 3 weeks for an anti-depressant effect to manifest. If the patient improves, continue medication for several months after recovery. 


If the patient doesn't improve, gradually change to the other anti-depressant. If repeated relapses, consider long-term maintenance treatment.


COGNITIVE BEHAVIOR THEORY (CBT)

The aim of CBT is to help the patient'to correct the negative cognitions and other unhelpful behaviors that maintain the depression because of negative cognitions and maladaptive behaviors can cause one to feel low in mood and which leads to depression.


Management Of Bipolar Depression-
  • Among atypicals: Quetiapine may be the drug of choice.

  • Among anti-epileptics: Lamotrigine may be the drug of choice.

  • For severe, treatment-resistant depression: ECT may be an option.

General Management Principles

  • Assess suicidal risk during depressive/mixed episodes.

  • Assess safety issues(to the patient and others as well) during manic episodes.

  • Identify and try to address contributory factors such as work stressors, physical health issues, alcohol misuse, etc.

  • Educate the patient about the illness and rationale of treatment.

  • Advice patients about Sleep Hygiene as disturbed sleep is a prominent risk factor for relapse and also for switching from Depression to Mania.

Long-term course of Bipolar Disorder-
    
  • The average duration of a Depressive episode is (months) is more than that of Manic episodes.

  • Women with the Bipolar disorder may experience more Depressive episodes than men with Bipolar disorder.

  • Patients with Bipolar disorder tends to have more and longer Depressive episodes in the course of their lifetime than patients with the Unipolar disorder.

  • On an average, a Bipolar patient will experience about 10 episodes in their lifetime with a roughly equal number of depressive/manic episodes.




Monday, 30 April 2018

Eating Dark Chocolate Can Improves Mental Health : 5 Incredible Benefits of Dark Chocolates

April 30, 2018

Can Dark Chocolates Really Help In Improving Stress?


 5 Incredible Benefits of Dark Chocolates

According to the recent study at Loma Linda University in Southern California, it has been suggested that eating a dark chocolate could be helpful for you to lower down your mental stress.


The researchers have found that dark chocolate contains a higher amount of cacao (70%) that actually helps in reducing the inflammation and stress level.

 Studies have also found that consuming dark chocolate gradually also helps in improving your mood and memory.

 So next time whenever you are feeling low or having bad mood do grab a dark chocolate bar one or two.

Same as in another study, the researchers had the healthy participants who took the equivalent of a chocolate bar --- 48 grams of dark chocolate which contains 30% of organic cane sugar and 70%  cacao. 

Later on, their brains were scanned with ECG which measures brain waves,30 minutes and 60 minutes after eating the chocolate. And guess what the gamma waves increased across the cortex which is mainly related to memory and cognition.


From child to adult chocolate has been a longtime favorite of all age, we do love to eat. As above studies already claim that eating dark chocolate is helpful to reduce stress, but there are so much more good about eating dark chocolates such as: 


1) Dark chocolate improves mood, stress, memory, and immunity.


2) Dark chocolate contains anti-oxidants which have a capacity to prevent aging by free radicals. 


3) It also helps to keep your skin healthy and glowing.


4) Dark chocolate helps to boost our brain power, cocoa is rich in antioxidants called flavanols which dilates blood vessels allowing more oxygen and blood to the brain. 

The antioxidant reduces inflammation throughout the body which can eventually lead to heart disease, cancer, aging.


5)Dark chocolate contains a large amount of Amin (amino acid) and acts as an effective natural sex enhancer by increasing nitric oxide and blood flow to sex organ which increases sensation, satisfaction, and desires.

 It also contains a chemical called P (Phenylethylamine) which promotes the production of neurotransmitter dopamine which enhances feelings of well-being, joy, and pleasure.


Also, read- :)

10 Effective Foods To Eat Daily To Beat Your Depression And Anxiety

Personality Disorder: Types, Causes And Symptoms :Cluster A, Cluster B and Subtypes

April 30, 2018

What is a Personality Disorder?

Personality Disorder: Types, Causes And Symptoms :

A Personality Disorder is a type of mental disorder in which a person has the unhealthy pattern of thinking, behaving and functioning. 


According to the ICD-10 the Personality disorder is defined as 

"Characteristic and enduring pattern of inner experience and behavior, that, as a whole, deviates markedly from the culturally, expected and accepted range.


 Usually, Personality Disorder started in teenage or in early adulthood.




Major Symptoms Of  Personality Disorder:

   Persistent, maladaptive, inflexible patterns:
  • Of thinking(about self, other and the world)

  • Feeling(intensity of emotions)

  • Behavior

  • Relationship with others

  • Cause significant distress to self and to others.


                    Types Of Personality Disorder:


1) Cluster A (Odd or Eccentric disorder)

     Cluster A personality disorder includes- Paranoid Personality Disorder, Schizoid Personality Disorder and Schizotypal Disorder.
  
a) Paranoid Personality Disorder
  • Pervasive mistrust/suspiciousness - misinterpreting friendly or neutral actions of others as hostile.
  • Self- referential attitude.

  • A tendency to bear grudges.

  • A combative sense of personal rights.

  • Excessive sensitivity to criticism and setbacks.

  • Preoccupation with conspiratorial explanations for personal or universal events.


b) Schizoid Personality Disorder
  • Inability to express both positive tenders feelings as well as negative feelings like anger.

  • No desire for relationships or close friends.

  • Emotional coldness/ detachment.

  • Indifference to criticism or praise.

  • Unintentional disregard for social norms.


c) Schizotypal Disorder

  • Appearance and behavior are odd and eccentric.

  • The tendency to social withdrawal.

  • Old Belief.

  • Paranoid Ideas.

  • Ruminations involving violent or sexual themes.

  • Depersonalization / Derealization / illusions.

  • Transient quasi-psychotic episodes.


2) Cluster B Personality Disorder


Cluster B Personality disorders are characterized by dramatic, erratic and emotional behavior. 

They include- 

Antisocial Personality Disorder,

Borderline Personality Disorder, 

Histrionic Personality Disorder, 

Avoidant Personality Disorder, 

Dependent Personality Disorder, 

Obsessive-Compulsive(Anankastic) Personality Disorder, 

Passive-aggressive Personality Disorder



a) Antisocial Personality Disorder: This disorder is also known as Dissocial Personality Disorder in ICD-10. Other related terms include Psychopathic Personality, Sociopathic Personality, Dangerous and Severe Personality disorder.

  • Low threshold for aggression/impulsivity resulting in fights, assaults.

  • Incapacity to experience remorse and to learn from punishments.

  • Can easily establish relationships, but ain't maintain them.

  • Callous unconcern for feelings of others.

  • Disregard for social rules as evidenced by repeatedly breaking the law.

b) Borderline Personality Disorder:

A borderline personality disorder is generally characterized by unstable effects of intense anxiety, irritability that last usually for only a few hours at a time.


  • Involvement in intense, unstable relationships in which the other person is alternately idealized and devalued.

  • Recurrent threats or acts of self-harm, especially self-mutilation.

  • Chronic feelings of emptiness.

  • The patient makes frantic efforts to avoid abandonment.

  • A tendency to quarrelsome behaviors.

  • A tendency to act impulsively without consideration of results such as alcohol, drugs, sex, driving, etc.

  • Frequent outbursts of anger or violence, physical fights.

  • A patient may expierence dissociative symptoms, paranoid ideas, etc.



c) Histrionic Personality Disorder
  
   Histrionic Personality Disorder is characterized by wanting to be the center of attention in events that one participates.

  • Usually, the patient feels uncomfortable in situations where one cannot be the center of attention.

  • Exaggerated expression of emotions.

  • Shallow and labile affect.

  • Theatrical speech that lacks specific details.

  • Inappropriate seductiveness in behavior.

  • Over-concern with physical attractiveness, in an attempt to draw the attention of others.

  • Easily suggestible and influenced by others.

  •  Histrionic Personality Disorder is associated with Somatization Disorder.



d) Narcissistic Personality Disorder
Named after Narcissus, a hunter in Greek mythology, who fell in love with his own reflection in a pool of water.

  • A belief that one is special.

  • Lack of empathy: inability/unwillingness to identify with the feelings of others.

  • Envious of others, but also feels that others are envious of her/him.

  • Arrogant attitude or behavior.

  • Need for an excessive admiration or attention seeking.

  • Preoccupation with fantasies of success, power, beauty, ideal love, etc.

  • Exploitation of others in relationships and taking advantages of others to achieve one's goal.


e) Avoidant Personality Disorder
  • Avoidance of activities that involve interpersonal contact for fear of criticism or rejection.

  • A belief that one is inept, unappealing or inferior to others.

  • Preoccupied with the fear of being criticised or rejected in social situations.

  • General feelings of tension.

  • Restrictions on lifestyle because of the need for physical security.

  • Unwillingness to get involved unless certain of being accepted and liked.



f) Dependent Personality Disorder

 In Dependent Personality disorder the person excessively depending on others for an emotional support.

  • Inability to make even everyday decisions without advice or reassurance from others.

  • Allowing others or wanting others to make important life decisions.

  • Subordinating one's own needs to the needs of those that one depends on.

  • Difficulty in doing things due to lack of self-confidence.

  • Fear of losing support.

  • Feeling helpless when alone.

  • Preoccupied with exaggerated fears of being unable to care for oneself if alone.


g) Obsessive-Compulsive(Anankastic) Personality Disorder

  • Preoccupied with Perfectionism.

  • Excessive doubting.

  • Preoccupied with details, lists, rules, etc that interferes with the main objective of the task being done.

  • Excessive conscientiousness and inflexibility with morals, ethics, and values.

  • General Stubbornness.

  • Rigid adherence to social conventions


h) Passive-aggressive Personality Disorder

  • Procrastination.

  • Failing to do one's share of teamwork.

  • Avoids obligations by claiming to have forgotten.

  • Protesting that others make unreasonable demands.

  • General disdain for people in authority.

  • Sulkiness/irritability when asked to do something that one doesn't want. 



Sunday, 29 April 2018

Personality Disorders :Assessment, Management and Treatment

April 29, 2018

        Assessment of Personality Disorders



Personality Disorders :Assessment, Management and Treatment
  • Personality Disorder shares many common features with functional Mental Disorder. The main differentiating feature is that in Personality Disorder, the one set is early and the features have been persistent and stable, while in functional Mental Disorder, the onset is usually later and the symptoms tend to be episodic. However, this distinction is not clear.

  • Knowing the background personality in a patient with a Mental Disorder helps the Clinician be more realistic with respect to the treatment outcome expectations.

  • So, it is very important to access the patient's Personality as a part of the initial assessment(usually with extra information from another source such as Parents, Siblings, Spouse, Family, Physician, etc) who has known the patient for many years.


  •   It is generally not appropriate to make a diagnosis of a Personality Disorder after just one Assessment session. Usually, a  patient would need to be seen at least a few times.

  • Previous Medical/Psychiatric records, if available, should also be studied.

  • while the exception of Borderline Personality Disorder, most other Personality Disorders are diagnosed the only incidentally in routine psychiatric services in patients presenting with other problems like Psychosis, Depression, Anxiety, etc.

  • Patients with a Personality disorder are at higher risk of developing Mental Disorder.


Management Of Personality Disorder


Apart from the Borderline PD, the vast majority of patients with Personality Disorders(with no co-morbid Mental Disorder) do not to the attention of mental health services. Hence, most of the studies of treatment have been on Borderline PD.


The other Personality Disorders are usually incidentally diagnosed in patients presenting with the other disorders like Depression, Anxiety, Psychosis or Addiction.


 Antisocial PD is, as expected, very common in the prison/criminal justice settings. It is usually diagnosed formally only after the person has committed a crime.


Management Of Borderline Personality Disorder:

 The goals of treatment include:

  • Better management of one's emotion.

  • Avoidance of / reduction of self-harm behavior.

  • Having more clarity about one's purpose in life.

  • Building better quality relationships with others.

  • Improvement in functioning.

  • Addressing the co-morbid Psychiatric/substance misuse issues.

Psychotherapy for Borderline PD-

    • Psychodynamic Psychotherapy

    • Dialectical Behaviour Therapy (DBT)

    • Transference-Focused Psychotherapy (TFT)

    • Mentalisation -Based Therapy (MBT)

    • Emotion Regulation Training (ERT)

    • Cognitive Behaviour Therapy (CBT)

    • Schema-Focused Therapy (SFT)

    • Interpersonal Psychotherapy (IPT)

 Pharmacotherapy for Borderline PD


  • Not used as a primary treatment as it is unlikely to alter the natural course of the disorder.

  • Mainly used for symptoms management.

  • Risk of overdose needs to be borne in mind while prescribing psychotropics.

  • Drugs that may have some benefits include:
              a) Antidepressants: usually SSRIs.

              b)Antipsychotics: usually low/dose atypicals.

              c)  Mood stabilizers: e.g. Valproate, Lithium.

                     d) Others e.g. Clonidine, Omega-3 fatty acids.



Management Of Paranoid Personality Disorder-

Patient with Paranoid Personality Disorder is very difficult to treat as they are mistrustful of most people, including Psychiatrists. A patient with Paranoid PD is unlikely to present for treatment unless there are significant immediate problems. 


For examples, a patient may be at risk of losing a job because of complaints from colleagues or a wife is deciding to leave unable to tolerate suspicious nature of the husband.


Low dose Antipsychotics may be helpful.



Treatment for Personality Disorders


If the patient is willing and motivated to change, and depending on the PD, and the availability of services the following treatments may help.


  • Psychotherapies: ranging from Supportive, through CBT, to Exploratory therapies like Psychodynamic Psychotherapy.

  • Self-help: books and online support groups.

  • Treatment of any co-morbid disorders such as Depression, Anxiety, etc with Medication or Psychotherapy to optimize functioning.







Friday, 27 April 2018

Conversion Disorder: PNES,Trance, Possession disorders Signs, Symptoms and Management

April 27, 2018

Conversion Disorder


Conversion Disorder refers to the presence of sensory and or motor symptoms without an adequate underlying medical explanation. 


The word 'Conversion' is used as the assumption is that psychological distress is 'converted' into physical(usually neurological) symptoms. 

Other terms that are used by clinicians for Conversion Disorder are as 'Non-organic', Psychosomatic, etc
What is a Conversion Disorder?

Examples of Psychological stressors in children are as follows:

  • Being bullied at school.

  • Parental separation.

  • Illness or death of a parent, sibling or a friend.

  • Beak-up

  • Physical, emotional or sexual abuse.

List of Conversion Disorders-

1) Motor:
  • Weakness
  • Loss of speech
  • Limb paralysis
  • Abnormal movements

2) Sensory:
  • Anesthesia
  • Paraesthesia
  • Loss of sight, touch or hearing

3) Mixed Sensory and Motor.


4) Psychogenic non-epileptic seizures (PNES) previously known as pseudoseizures.

Dissociative(Conversion) Disorders in ICD (International Classification of Disease)-10
  1. Dissociative Amnesia
  2. Dissociative Fugue
  3. Dissociative Stupor
  4. Trance and Possession disorders
  5. Dissociative motor disorder
  6. Dissociative convulsions
  7. Dissociative anesthesia and sensory loss
  8. Other Dissociative disorders: 
  •     Ganser's syndrome
  •   Multiple personality disorder

1-Dissociative Amnesia- The patient undertakes an unexpected yet seemingly organized journey away from home, or from their ordinary place of work and social activities. 


There is amnesia, either partial or complete, for the journey.



 2-Trance and Possession disorders- There is a temporary alteration of the states of consciousness, loss of personality, repetitive repertoire of movements and speech.  


Whereas, in Possession disorder, an individual behaves as if taken over by a spirit, deity or higher power. The patient's such behaviors occurring in culturally-sanctioned religious rituals are not diagnosed as pathological.


3-Multiple Personality Disorder- Multiple Personality Disorder also called Dissociative Identity Disorder, in this disorder, the person displays two or more distinct personalities. 

At any one time, one personality takes full control. Each personality has its own memories and behaviors patterns.


EPIDEMIOLOGY OF CONVERSION DISORDERS-

  • More common in females in both adults and children.

  • Can occur at any age but (rare in under age of 8 years, or for a first episode after the age of 35 years).

  • Motor symptoms are common such as paralysis and weakness.

  • These disorders seem to be more common within those with lower levels of education, (particularly lack of medical knowledge.

  • More common in developing countries than in affluent nations.

  • More common in lower socio-economic classes.

  • More common in rural areas than in urban areas.

  • Conversion Disorders are mainly associated with co-morbid depression or anxiety disorder and antisocial personality disorders in males.


FACTORS SUGGESTING CONVERSION DISORDER 


  • Symptoms follow a psychological stressor.

  • Presenting symptoms are atypical.

  • Elicited signs are atypical.

  • Investigations are normal or not consistent with the severity of symptoms.

  • Past history of conversion disorder.

  • Past history of depression/ anxiety and family history of depression/anxiety.


                Psychogenic Non-epileptic Seizures (PNES)

Previously PNES is known as Pseudoseizures, Psychogenic seizures, and Non-epileptic seizures. In ICD-10 PNES is called 'Dissociative convulsion'. 


The usual onset of PNES is in early adulthood but can also occur in children and elders as well. According to the report, it's more common in females (F: M ratio of 7:3).


Factors Suggestive of PNES-

  • Occurrence only in front of an audience (viz. Family)

  • No loss of consciousness.

  • No tongue biting or major injury.

  • Bicycling of leg movements(during the episode).

  • No incontinence. 

  • Side to side turning of the head.

  • Emotional triggers such as arguments and panic attacks.

  • Weeping or stuttering during the episode.

  • Shallow breathing.

  • Multiple vague somatic symptoms such as pain and fatigue.


PNES Management-

  • Supportive counseling.
  • Anxiety management and relaxation training.
  • Cognitive Behaviour Therapy(CBT).
  • Psychotropics such as Antidepressants and Benzodiazepine could be helpful for the patient.

Other helpful and useful recourses-

Conversion Disorder Forum.

Conversion Disorders Forums



Thursday, 26 April 2018

Eating Disorders: Anorexia Nervosa, Bulimia and BED- Symptoms, Epidemiology And Etiology

April 26, 2018

Eating Disorders


Studies show that 1/3 of boys and one-half of girls have engaged in some kind of unhealthy behavior to control the weight behaviors like fasting, skipping meals and smoking for their weight down. 


Few facts about eating disorders and also some signs that it's time to seek help.  A diet is not the same thing as an eating disorder but diets can lead to eating disorders because they encourage preoccupation with food and with your weight.


Eating Disorders Anorexia Nervosa, Bulimia and BED- Symptoms And Aetiology orders
 One of the common myths about eating disorders and dieting is that it's all about the weight but its wrong in fact diets can actually give us a perceived sense of control over our lives, taking a diet to the extreme can have serious consequences for your mental and physical health. 


The negative side effects of extreme dieting can include a preoccupation with food. Actually, extreme dieting has been proven to lower your metabolism over the long term which makes it even harder to lose weight and stay fit in the future.



Etiology of Eating disorders- The exact etiology of an eating disorder is still not known yet. But the best way to consider eating disorders as having a complex multifactorial etiology involving cultural, family, genetic, and other biological factors as well.


 For many years AN was thought to be primarily culturally influenced disorders. High co-morbidity with Depression and Anxiety disorders suggests possible shared etiology with those disorders. 


Other potential risk factors include- Early childhood eating, childhood sex abuse.


  Whereas, low confidence(poor self-esteem) and excessive self-criticism are seen in both Anorexia Nervosa and Bulimia Nervosa. 


An obsessive-compulsive personality(Perfectionism) disorder is associated with AN and  Borderline personality disorder (impulsivity) is associated with BN.


(Also, read Personality Disorder: Types, Causes, And Symptoms: Cluster A, Cluster B, and Subtypes.)



Types of Eating Disorders: Signs and Symptoms


                         1. Anorexia Nervosa (AN)


1). Clinical symptoms of Anorexia Nervosa are as follows-

  • Reduced body weight.

  • Self-perception that one is too fat 

  • Intense fear of gaining weight and becoming fat

  • Self-induced weight loss by starvation, vomiting, excessive exercise, misuse of laxatives, appetite suppressants, etc.


2). Common behaviors are seen in Anorexia Nervosa-

  • Wearing multiple layers of clothing.

  •  While eating- cutting food into small pieces, eating very slowly/picking at foods.

  • Counting calories in food items(before eating).

  • Preparing elaborate meals for others.


                                 2. Bulimia Nervosa

1). Clinical Symptoms of Bulimia Nervosa-

  • A strong desire or compulsion (craving) to eat.

  • A large amount of food consumed within a short period(i.e under 2 hours).

  • Lack of control over eating.

  • Self-perception of being too fat (even a person having a normal weight).


                                      3. Binge Eating Disorder  


1). Clinical Symptoms of Binge Eating Disorder-

  •  Eating more faster than usual.

  • Eating even when not hungry.

  • Eating alone(due to embarrassment).

  • Feeling disgusted with self or guilty afterward.

  • No compensatory behaviors like starvation and vomiting 

Types of food that are consumed in Binge eating disorders are mainly cakes, ice-creams, donuts, cookies, chips, etc.
According to the definition, a patient with Anorexia Nervosa has an underweight, a patient with  Bulimia Nervosa are usually with a normal weight and patient with BED tends to have an overweight.



Epidemiology of Anorexia Nervosa-



The Lifetime Prevalence of Anorexia Nervosa is about 1% in the community among females. According to the studies it is more common in females.


  • Incidence is about 8 per 100,000 population.

  • Highest Incidence (more than 100 per 100,000) is in the 15 to 19 age group.



Epidemiology of Bulimia Nervosa-

The Lifetime Prevalence of Bulimia Nervosa is about 2% (in females).


  • Incidence is about 12 per 100,000 population.

  • Much  more common in females with an F: M ratio of  about 5:1

  • Age of onset is decreasing: Highest Incidence used to be in the 25 to 29 age group, but now it is the 15 to 19 age group (due to early detection).


Epidemiology of Binge Eating Disorder-

Lifetime Prevalence is about 4% in females and 2% in males, so F: M ratio is about 2:1
  • The peak age of Incidence is between in the ages of  25 and 34 years.

Other helpful resources:

Epidemiology of Eating Disorders






Epidemiology and Course of Anorexia Nervosa in the Community




Sunday, 22 April 2018

Mood Disorders- Depression Vs Bipolar Disorder :Symptoms, Neurobiology And Treatment

April 22, 2018

Depression vs Bipolar Disorder


Mood disorders are also known as 'Affective' disorders the two main mood disorders are DEPRESSION AND BIPOLAR DISORDER. Patient with depression(both Unipolar and Bipolar) and Mixed states of Bipolar disorder are at increased risk of suicide.

   About 5 to 10% of patients with untreated /inadequately treated Unipolar Depression commit suicide and about to 10 to 15% of patients with Bipolar disorder commit suicide.



Mood Disorders- Depression Vs  Bipolar Disorder :Symptoms, Neurobiology And Treatment

In Depression, the patient experiences one or more episodes of low mood which is also called 'Unipolar' disorder. Whereas in bipolar disorder the patient experiences episodes of both low mood(depression) and abnormally elevated mood which could be either Hypomania or Mania, or the patient might experience 2 or more episode of abnormally elevated mood (i.e Hypomania or Mania).  



 Clinical Symptoms of depression- 

  • A depressed mood that is clearly abnormal for a person.

  • Inability to derive pleasure from normally pleasurable activities.

  • Reduced concentration

  • Sleep disturbance.

  • Appetite disturbance(usually decreased or low weight).

  • Increased fatiguability.

  • Retaradtion.

  • Feeling hopeless, helpless, worthless.

  • Suicidal ideation/plans/acts.

Difference between Mania and Hypomania

  • Mania represents a more severe form of abnormally elevated mood than Hypomania. 

  • Patient with Hypomania has insight into their illness.

  • Patient with  Mania tends not to have insight.

  • Patient with Hypomania never has psychotic symptoms.

  • Patient with Mania may or may not have psychotic symptoms.

Clinical Features of Hypomania 
  • An elevated mood that is clearly abnormal for the person.

  • Increased activity or restlessness.

  • Increased energy.

  • Less sleep.

  • Increased sociability.

  • Decreased concentration. 

Clinical Features of Mania
  • Irritable moods that are clearly abnormal.

  • Severe interference with a personal functioning.

  • Grandiosity/increased self-esteem.

  • Restlessness

  • Disinhibition/inappropriate behavior.

  • Increased perceptual sensitivity.  


                            Depression in Bipolar Disorder

Some symptoms that may suggest bipolar depression:
  • Atypical features (increased sleep, and appetite).

  • Psychomotor retardation.

  • More frequent episodes.

  • A family history of bipolar disorder.

  • Male gender(equal gender for prevalence for bipolar).

  • More abrupt onset.

  • Easily destructible and unable to focus.

  • Engage in risky behavior.



                                  Rapid Cycling Of Bipolar disorder

At least four mood  episodes (hypomania/mania/depression) should occur within  a 12-month period and these episodes are demarcated by: 
  •  period of remission.

  • switch to an episode of opposite polarity.

  • switch to an episode of mixed polarity.

The common risk factors that include are alcohol abuse, Thyroid dysfunction, life stressors, relatively less responsive to treatment and a higher risk of suicide.



Neurobiology Of Mood Disorder-

Depression has been studied far more than Bipolar disorder. Depression reduced the volume of  Hippocampus bilaterally (whether a cause of effect or illness) also it reduced the activity of dorsolateral prefrontal cortex. Whereas in Bipolar disorder, studies have shown the inconsistent results in Hippocampal volume. Other systems potentially involved in Mood disorders :

  • Endocrine: e.g HPA axis dysregulation; Oestrogens

  • Immune system 

  • Abnormalities in emotional processing 

  • Role of Neurotrophic factors: e.g. BDNF




Where can a patient get help?

If you also have bipolar disorder and experiencing those symptoms then please do call to your counselor or physician or your therapist or psychiatrist but if you feel suicidal or having suicide ideation then please call at 911




How is Bipolar disorder treated?

Bipolar disorder can be treated now just like other diseases there are psychotherapy and safe medications. So if you are also going through the Bipolar disorder so, please seek help and see your physician or therapist because doing so will help you to get back into your normal life.

*Some other adjunctive treatment options for mood disorders

  • Physcho-education

  • Guided self-help

  • Phototherapy

  • Yoga

  • Acupuncture

  • Sleep Deprivation

  • Exercise Programmes.