Home Archive Nr. 2 (37) Bipolar Disorder – focus on depression
The prevalence of bipolar disorder (BPR) during life is 4.5%. This disease is associated with premature death and is one of the leading causes of disability in the developed countries of the world among people aged 15 – 44 years. Thus, the level of completed suicides is about 5% among persons who have never been treated in the hospital, and 25% in patients in the early stages of the disease. BDP is often associated with other conditions, in most cases, anxiety disorders and substance abuse. The M. Frye article, published in the New England Journal of Medicine (2011; 364 (1): 51 – 59), discusses various approaches to the management of BDP, and also provides a brief overview of the official guidelines.
BPR is characterized by high morbidity and mortality. It is characterized by recurrent episodes of mania or hypomania and depression. The criterion for BPR is at least one episode of mania (BPR I) or hypomania (BPR II) (Table 1).
A more pronounced increase in mood and disability associated with it distinguishes mania in patients with BPR I (characterized by psychosis, the need for emergency care or hospitalization, a marked deterioration in mental state) from hypomania with BPR II. Unlike patients with mania, those with hypomania rarely seek medical help, except when the diagnosis of BPD is already established and the patient is concerned about the progression of the disease (for example, the occurrence of an episode of mania). While the old term “manic-depressive psychosis” implied the presence of a depressive episode after each episode of mania, many patients had one or more episodes of depression before the first episode of mania (or hypomania), after the occurrence of which the diagnosis of BPD was established. The diagnostic criteria for a depressive episode with BPD are the same as for unipolar depressive disorder.
Despite the fact that the severity of mania is obvious, disability associated with BPD occurs more often in the depressive phase. According to one study, significantly more working days per year were lost by patients with BPD than with unipolar depression (Kessler et al., 2006). The difference was primarily due to recurrent depression, not mania. Episodes and subclinical symptoms of depression usually last longer than episodes and subclinical symptoms of mania. The National Institute of Mental Health conducted a depression study in people with BPD I that was observed for more than 12 years, and the symptoms were almost 50% of the time. Symptoms of depression were observed during one third of the entire period of the disease, symptoms of mania – 10%, mixed symptoms – about 6%. Subclinical symptoms of depression are also associated with functional disability and subsequent relapse of depression.
Diagnostic criteria for depressive disorder *
1. The episode lasts at least 2 weeks, during which 5 or more symptoms are noted (at least one of the symptoms should be decreased mood, loss of interest or pleasure from almost any activity).
2. Changes in appetite or decrease / increase in body weight, insomnia or hypersomnia, psychomotor agitation or lethargy are observed; reduced energy levels; self-worthlessness or guilt; difficulties of mental activity, reduced concentration of attention or difficulty in making decisions; recurring thoughts of death, planning suicide or his attempts.
3. Symptoms are new or more severe than before the depressive episode, most of the time, almost every day, for at least 2 weeks in a row.
4. The episode is accompanied by clinically significant distress or deterioration of social, professional functioning or functioning in another important area of life.
5. Symptoms are not the result of severe loss (death of relatives) or the mental effect of drugs, somatic illness, or the consequence of substance abuse.
Note: * – when depressed, a person’s mood is described as depressed, sad, hopeless, depressed, or “depressed” (criteria of the American Psychiatric Association).
Diagnosis of BPD
The initial assessment of a patient with depressed mood should include screening for alcohol and other psychoactive substance abuse, an assessment of suicidal behavior, personal and family psychiatric history, physical examination and laboratory tests to exclude additional health problems that may cause these symptoms. Chatting with relatives or other close people can be helpful for getting more information, especially regarding the severity of the symptoms. The presence of BPR in the family history,symptoms of up to 25 years and frequent short episodes (for example,