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The world of Bipolars

July 1, 2020, 11:51 a.m. by Dr.Brushabhanu Karan ( 608 views)

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Bipolar disorder or bipolar affective disorder(BPAD) previously known as manic depressive psychosis (MDP) is the most important neuropsychiatric disorder not because it is so common affecting around 2.6% of the global population but of its varied implications in personal, social, political, religious & artistic spheres.

Initially described by Emil Kraepelin as the name suggests it has two poles viz.upper or manic state & lower or depressive state & as per the ICD guidelines to make a diagnosis of bipolar disorder one must have at least one episode of mania or hypomania.

It is mostly of two types viz.bipolar I when depression alternates with mania & bipolar II when depression shuffles with hypomania and there's also type III, type IV & cyclothymia but these are not so common. It presents commonly in four stages viz.manic/hypomanic/mixed/depressive.

In manic, state patient is highly excited, irritable, impulsive, restless, talkative & have grandiose ideas.

In the hypomanic state, all the above symptoms but to a lesser degree & sometimes so mild that it goes unnoticed or considered as creative/dashing/highly sociable.

In a mixed state, the patient has both manic/hypomanic & depressive symptoms of various intensity simultaneously so that while crying he/ she also becomes excited & emotional. The depressive stage of bipolar disorder presents like any other depression but with some characteristics like rapid onset & progress so that patient becomes a statue & has hypersomnia (excess sleep), hyperphagia (excess eating).

The disease is so important because it is present everywhere & next to you but so commonly ignored. It is so easy to diagnose as no other human illness has such typical bipolar features but globally it takes average ten years to have a correct diagnosis even in the USA. It strikes at very young ( between 15 to 25) & productive age of life. It is a lifelong disorder but presents episodically & person remains normal in between. It is so difficult to diagnose because it presents in innumerable ways Viz. substance abuse, marital problems, job problems, aggression, suicide, sudden success & then failure like some famous godmen in India. In the maniac/ hypomanic stage, they have colorful attires like bright colorful dresses, excess ornaments, uncommon hairstyles, spending sprees & people become their followers while in the depressive stage they hide from public & seek treatment.

'Depression', the medical disorder often discussed in media & public is normally the unipolar depression. Bipolar disorder is often misdiagnosed as unipolar depression because it mostly presents with depressive symptoms & develops manic/hypomanic symptoms later in life. So any person who presents with depressive symptoms should be enquired of maniac / hypomanic symptoms in their past.

The good thing about this illness is that it is immensely treatable & with regular treatment, one can lead a normal life & achieve his/ her potential. But common sense is very uncommon & most of them stop their treatment after recovery and they relapse sooner or later.

The paradox about this very common illness is that the public is blissfully ignorant of it & even the term bipolar disorder.

Also, the term mental is pejorative as people think one can control one's mind but the truth is that all the mental disorders are as physical as diabetes or hypertension because the problem lies in the brain & genes play a great role. Hence the term 'neuropsychiatric' connotes better as it implies psychiatric symptoms having a neuronal origin.

Medical treatment is the sheet anchor but public awareness is the light through which we can see where to fix it.

-Dr.Brushabhanu Karan,MD(psychiatry),SCB Medical College,Cuttack

-Practising at BHUBANESWAR.

Comments (1)

Pammi1234 8 months, 4 weeks ago