Manic-depressive psychosis in women: how to treat? Manic depression. Manic-depressive psychosis: treatment, symptoms, causes

Pathologies of a person's mental state can be associated with the degradation of his personal characteristics or with the preservation of all basic parameters. In the second case, the disorders are less acute, and the ability to fully restore the psyche over a certain period of time is preserved. Such diseases with a "temporary" course include manic-depressive psychosis.

It manifests itself in the form of cyclic mood swings: periods of violent (manic) activity are replaced by recessions in the form of depression and depression. In time, these cycles can be separated by months and years of normal functioning of the mental sphere of brain activity. At the same time, no symptoms of manic-depressive syndrome appear.

In the vast majority of cases, it is diagnosed in women of middle and advanced age. The initial complex of clinical manifestations may occur against the background of a midlife crisis or hormonal changes in the body in the menopause. Both social and personal factors can influence.

The main provocative factor on which all other causes of manic-depressive psychosis are based is negative genetic heredity. As a rule, in the family there are several recorded cases of the disease in people belonging to different generations. But there is a practice of observations in which a clear connection may not be observed. This occurs in cases where in older women all manifestations are attributed to gerontological personality changes, quarrelsome character.

The transmission of the defective gene occurs after 1 generation. Thus, in one family, a grandmother and her granddaughter may suffer from clinical signs of manic-depressive psychosis at the same time.

The causes of manic-depressive psychosis are imposed on heredity, which would rather be called triggers:

• changes in the endocrine system of the body (nodular goiter, thyroid dysplasia, adrenal dysfunction, Graves' disease);
• disruption of the hypothalamus and analytical fragmentary center of the brain;
• menopausal hormonal changes;
• painful menstruation;
• postpartum and prenatal depression.

Among social and personal factors, it can be noted that persons who are prone to the appearance of signs of manic-depressive psychosis are:

• suffer from a sense of their own inferiority (this also includes various complexes);
• cannot realize their inclinations and abilities;
• they do not know how to get in touch with other people and build full-fledged relationships;
• do not have a stable income and sufficient material support;
• received serious psychological trauma as a result of divorce, breakup, betrayal, betrayal.

There are other causes of manic-depressive syndrome. They can be associated with head injuries, organic lesions of brain structures against the background of strokes and cerebrovascular accidents, meningitis.

Depressive-manic psychosis and its classification

To prescribe the correct compensatory therapy for a psychiatrist, it is important to correctly classify depressive-manic psychosis according to the degree of manifestation of its clinical symptoms.

For this, a standard scale is used, according to which 2 degrees are distinguished:

1. the absence of pronounced signs is called cyclophrenia;
2. a detailed clinical picture with severe manifestations is called cyclothymia.

Cyclophrenia is much more common and can be latent for a long period of time. These patients have frequent mood swings for no apparent reason. Under the influence of a stress factor, a person can plunge into the primary phase of depression, which will gradually turn into a manic cycle with intense emotional arousal and a burst of energy and physical activity.

Symptoms of manic-depressive psychosis

The clinical symptoms of manic-depressive psychosis depend on the degree of damage to the mnestic sphere of a person. With cyclophrenia, the signs of manic-depressive psychosis are weak and differ in the latent course of the disease. Very often, in middle-aged women, they disguise themselves as premenstrual syndrome, in which a woman develops irritability, mood swings, impulsiveness, and a tendency to tantrums in the period before menstruation.

In old age, the symptoms of depressive-manic psychosis in the form of cyclophrenia can be hidden behind a feeling of loneliness, depression, and impaired social contact.

There is a seasonal link: afferent disorders appear cyclically at the same time every year. Typically, the crisis periods are deep autumn and early spring. Prolonged forms are diagnosed, in which depressive-manic psychosis shows signs throughout the winter, from late autumn to mid-spring.

Patients may present with:

• general mental lethargy, which after a few days can be replaced by pronounced excitement and joyful mood;
• refusal to communicate, with a sharp change in mood towards obsessive pestering other people with conversations;
• speech disorders;
• immersion in one's own experiences;
• the expression of fantastic ideas.

Clinical forms of cyclophrenic manic-depressive psychosis are widespread, in which a long-term phase of depression with bursts of manic behavior is distinguished. Upon exiting this state, a complete recovery is observed.

More pronounced are the symptoms of depressive-manic syndrome in cyclothymic form. Here, in addition to mental disorders, somatic and autonomic symptoms of manic-depressive psychosis may occur.

Among them are:

• a tendency to search for various "deadly" diseases against the background of depression;
• ignoring the clinical signs of a somatic disease against the background of a manic phase;
• psychogenic pain syndromes;
• disorders of the digestive process: lack or increase in appetite, tendency to constipation and diarrhea;
• tendency to insomnia or constant drowsiness;
• cardiac arrhythmias.

The appearance of a patient suffering from signs of manic-depressive psychosis in the stage of depression is quite characteristic. These are lowered shoulders, a dreary and sad look, the absence of movements of the facial muscles of the facial zone, self-absorption (the patient does not immediately answer the question asked of him, does not perceive the appeal to him). When the phase changes to the manic stage, an unhealthy gleam in the eyes appears, the patient is agitated, he has constant physical activity. Joy and aspiration to "exploits" are imprinted on the face. To simple questions that require a monosyllabic answer, the patient begins to give out whole theories and lengthy reasoning.

Manic-depressive psychosis can last a few days, or it can haunt a person for years and decades.

Treatment of manic-depressive psychosis

Pharmacological treatment of manic-depressive psychosis is required in patients with cyclothymia. With cyclophrenia, a change in lifestyle, active physical education, and attendance at psychotherapy sessions are recommended.

With the severity of symptoms of depression, antidepressants are prescribed: azafen, melipramine, noveril or amitriptyline. Sidnocarb and mesocarb can be used for a long time. Treatment always begins with the use of large dosages, which are gradually reduced to a maintenance level. Only a psychiatrist can calculate the dosage based on the data obtained from the history, height, weight, sex and age of the patient.

Alternative therapies include:

• extreme physical activity in the form of food deprivation, the possibility of sleep and heavy physical labor;
• electroshock methods of influence;
• electrosleep;
• acupuncture and reflexology.

At the stage of excitation, the treatment of manic-depressive psychosis is reduced to the suppression of excessive mental activity. Haloperidol, tizercin, chlorpromazine may be prescribed. These drugs should not be used without constant supervision by the attending physician.

(bipolar affective disorder) - a mental disorder that manifests itself as severe affective disorders. It is possible to alternate between depression and mania (or hypomania), the periodic occurrence of only depression or only mania, mixed and intermediate states. The reasons for the development have not been finally elucidated; hereditary predisposition and personality traits matter. The diagnosis is exposed on the basis of the anamnesis, special tests, conversations with the patient and his relatives. Treatment - pharmacotherapy (antidepressants, mood stabilizers, less often antipsychotics).

Causes of development and prevalence of manic-depressive psychosis

The causes of MDP have not yet been fully elucidated, however, it has been established that the disease develops under the influence of internal (hereditary) and external (environmental) factors, with hereditary factors playing a more important role. So far, it has not been possible to establish how TIR is transmitted - by one or several genes or as a result of a violation of phenotyping processes. There is evidence for both monogenic and polygenic inheritance. It is possible that some forms of the disease are transmitted with the participation of one gene, others - with the participation of several.

Risk factors include a melancholic personality type (high sensitivity combined with a restrained external manifestation of emotions and increased fatigue), a statothymic personality type (pedantry, responsibility, an increased need for orderliness), a schizoid personality type (emotional monotony, a tendency to rationalize, a preference for solitary activities). ), as well as emotional instability, increased anxiety and suspiciousness.

Data on the relationship between manic-depressive psychosis and the patient's gender vary. It used to be that women get sick one and a half times more often than men, according to modern studies, unipolar forms of the disorder are more often detected in women, bipolar - in men. The likelihood of developing the disease in women increases during periods of hormonal changes (during menstruation, in the postpartum and menopause period). The risk of developing the disease is also increased in those who have suffered any mental disorder after childbirth.

Information about the prevalence of TIR in the general population is also ambiguous, as different researchers use different assessment criteria. At the end of the 20th century, foreign statistics claimed that 0.5-0.8% of the population suffers from manic-depressive psychosis. Russian experts called a slightly lower figure - 0.45% of the population and noted that only a third of patients were diagnosed with severe psychotic forms of the disease. In recent years, data on the prevalence of manic-depressive psychosis are being revised, according to the latest research, TIR symptoms are detected in 1% of the world's inhabitants.

Data on the likelihood of developing TIR in children are not available due to the difficulty of using standard diagnostic criteria. At the same time, experts believe that during the first episode, suffered in childhood or adolescence, the disease often remains undiagnosed. In half of the patients, the first clinical manifestations of TIR appear at the age of 25-44 years, bipolar forms predominate in young people, and unipolar forms in middle-aged people. About 20% of patients suffer the first episode over the age of 50, while there is a sharp increase in the number of depressive phases.

Classification of manic-depressive psychosis

In clinical practice, the MDP classification is usually used, compiled taking into account the predominance of a certain variant of an affective disorder (depression or mania) and the characteristics of the alternation of manic and depressive episodes. If a patient develops only one type of affective disorder, they speak of unipolar manic-depressive psychosis, if both - about bipolar. Unipolar forms of MDP include periodic depression and periodic mania. In the bipolar form, four flow options are distinguished:

• Properly intermittent- there is an ordered alternation of depression and mania, affective episodes are separated by a light gap.
• Irregularly intermittent- there is a random alternation of depression and mania (two or more depressive or manic episodes in a row are possible), affective episodes are separated by a light gap.
• Double- depression is immediately replaced by mania (or mania by depression), two affective episodes are followed by a light interval.
• Circular- there is an ordered alternation of depression and mania, there are no light intervals.

The number of phases in a particular patient may vary. Some patients have only one affective episode during their lives, while others have several dozen. The duration of one episode varies from a week to 2 years, the average duration of the phase is several months. Depressive episodes occur more frequently than manic episodes, and on average, depression lasts three times as long as mania. Some patients develop mixed episodes, in which symptoms of depression and mania are observed simultaneously, or depression and mania quickly succeed each other. The average duration of the light interval is 3-7 years.

Symptoms of manic-depressive psychosis

The main symptoms of mania are motor excitation, elevation of mood and acceleration of thinking. There are 3 degrees of severity of mania. A mild degree (hypomania) is characterized by an improvement in mood, an increase in social activity, mental and physical productivity. The patient becomes energetic, active, talkative and somewhat distracted. The need for sex increases, for sleep it decreases. Sometimes instead of euphoria, dysphoria occurs (hostility, irritability). The duration of the episode does not exceed a few days.

In moderate mania (mania without psychotic symptoms), there is a sharp rise in mood and a significant increase in activity. The need for sleep almost completely disappears. There are fluctuations from joy and excitement to aggression, depression and irritability. Social contacts are difficult, the patient is distracted, constantly distracted. Ideas of greatness emerge. The duration of the episode is at least 7 days, the episode is accompanied by a loss of ability to work and the ability to social interactions.

In severe mania (mania with psychotic symptoms), marked psychomotor agitation is observed. Some patients have a tendency to violence. Thinking becomes incoherent, jumps of thoughts appear. Delusions and hallucinations develop, which differ in nature from similar symptoms in schizophrenia. Productive symptoms may or may not correspond to the mood of the patient. With delusions of high origin or delusions of grandeur, one speaks of the corresponding productive symptomatology; with neutral, weakly emotionally colored delusions and hallucinations - about inappropriate.

Depression causes symptoms that are the opposite of mania: motor retardation, marked depression of mood, and slowing of thinking. Loss of appetite, progressive weight loss. In women, menstruation stops, in patients of both sexes, sexual desire disappears. In mild cases, daily mood swings are noted. In the morning, the severity of symptoms reaches a maximum, by the evening the manifestations of the disease are smoothed out. With age, depression gradually acquires the character of anxiety.

Five forms of depression can develop in manic-depressive psychosis: simple, hypochondriacal, delusional, agitated, and anesthetic. With simple depression, a depressive triad is detected without other pronounced symptoms. With hypochondriacal depression, there is a delusional belief in the presence of a serious illness (perhaps unknown to doctors or shameful). With agitated depression, there is no motor retardation. With anesthetic depression, a feeling of painful insensitivity comes to the fore. It seems to the patient that in place of all pre-existing feelings, an emptiness has arisen, and this emptiness causes him severe suffering.

Diagnosis and treatment of manic-depressive psychosis

Formally, two or more episodes of mood disorders are required for the diagnosis of MDP, and at least one episode must be manic or mixed. In practice, the psychiatrist takes into account more factors, paying attention to the history of life, talking with relatives, etc. Special scales are used to determine the severity of depression and mania. The depressive phases of MDP are differentiated from psychogenic depression, hypomanic - with arousal due to lack of sleep, the use of psychoactive substances and other causes. In the process of differential diagnosis, schizophrenia, neuroses, psychopathy, other psychoses and affective disorders resulting from neurological or somatic diseases are also excluded.

Therapy for severe forms of MDP is carried out in a psychiatric hospital. In mild forms, outpatient monitoring is possible. The main task is to normalize mood and mental state, as well as achieve sustainable remission. With the development of a depressive episode, antidepressants are prescribed. The choice of the drug and the determination of the dose is made taking into account the possible transition of depression to mania. Antidepressants are used in combination with atypical antipsychotics or mood stabilizers. In a manic episode, normotimics are used, in severe cases - in combination with antipsychotics.

In the interictal period, mental functions are completely or almost completely restored, however, the prognosis for MDP in general cannot be considered favorable. Repeated affective episodes develop in 90% of patients, 35-50% of patients with repeated exacerbations become disabled. In 30% of patients, manic-depressive psychosis proceeds continuously, without light intervals. MDP often co-occurs with other psychiatric disorders. Many patients suffer from alcoholism and drug addiction.

The human psyche is a complex system, and failures can sometimes occur in it. Sometimes they are minor and corrected by several visits to a psychologist, but sometimes the problems can be much more significant. One of the serious mental disorders that require specialist monitoring is manic-depressive psychosis.

A distinctive feature of this disease is the alternating manifestation in a person of certain affective states: manic and depressive. These states can be called opposite, because manic-depressive psychosis is also called bipolar affective disorder.

Why do people get bipolar disorder?

It is believed that manic-depressive psychosis (MDP) is due to heredity: this is due to some disturbances in the transmission of nerve impulses in the hypothalamus. But, of course, it is quite difficult to determine this in advance, especially if the disease was not transmitted from the previous generation, but from more distant relatives. Therefore, risk groups were identified, among which cases of the onset of the disease are especially frequent. Among them:

• Constant stress on the psyche. It can be a job associated with negative emotions, or a difficult situation in the family - in a word, everything that day by day puts a person out of balance.
• Hormonal disruptions.
• Adolescence.
• Experienced violence - moral or physical.
• Presence of other mental illnesses.

Another characteristic feature of the disease is that, despite the tendency to emotionality and nervousness prescribed for women, it occurs precisely in females.

Signs of bipolar affective disorder

As already mentioned, for such a disease as manic-depressive psychosis, two "poles" are characteristic, two states - manic and depressive. Therefore, the symptoms of each of the phases should be described separately.

Manic stage

During this phase of bipolar disorder, the patient feels a sense of elation, joy, memory improves, and a desire to interact with the outside world arises. It would seem, and where are the symptoms of the disease? But still, the manic phase of such a disease as manic-depressive psychosis has some signs that make it possible to distinguish a painful state of the psyche from ordinary cheerfulness.

• Increased desire for risk, getting adrenaline. This may include gambling, extreme sports, the use of alcohol, psychoactive substances, etc.
• Restlessness, agitation, impulsivity.
• Fast, slurred speech.
• A prolonged, unconditioned feeling of euphoria.
• There may be hallucinations - both visual and auditory, tactile.
• Not quite adequate (or completely inadequate) perception of reality.

One of the main disadvantages of this condition is the commission of rash acts, which in the future can aggravate another stage of the disease - the depressive phase. But it happens that a manic syndrome exists in a person by itself, without the onset of depression. This condition is called manic psychosis, and it is a special case of unipolar disorder (as opposed to bipolar, which combines two syndromes). Another name for this syndrome is hypomanic psychosis.

depressive phase

Depression follows the manic phase of psychosis, during which the patient is extremely active. The following symptoms are characteristic of the depressive stage of the disease:

• Apathy, slow response to environmental stimuli.
• Low mood, craving for self-flagellation and self-abasement.
• Inability to concentrate on anything.
• Refusal to eat, talk even with loved ones, unwillingness to continue treatment.
• Sleep disorders.
• Slow, incoherent speech. The person answers questions automatically.
• Headaches and other symptoms that indicate the impact of depression on physical health: nausea, dizziness, etc.
• Perception of the surrounding world in gray, boring colors.
• Weight loss associated with loss of appetite. Women may experience amenorrhea.

A depressive state is dangerous, first of all, with possible suicidal tendencies, a person closing in on himself and the inability to carry out further treatment.

How is TIR treated?

Manic-depressive psychosis is a disease that requires very competent and complex treatment. Special drugs are prescribed, in addition, psychotherapy is used, as well as conservative therapy.

Medical treatment

If we talk about the treatment of psychosis with drugs, then we should distinguish between drugs designed for a long course and drugs, the main purpose of which is to quickly relieve the symptoms of a painful mental state.

Strong antidepressants are used to relieve acute depressive states. However, treatment with antidepressants must be combined with mood stabilizers, because otherwise the patient's condition may destabilize. As for the manic phase, here you will need medications that will help normalize sleep, remove overexcitation. You will need antipsychotics, antipsychotics, and all the same mood stabilizers.

Long-term treatment is designed not only to remove the consequences of affective states, but also to stabilize the patient's condition during periods of "calm". And in the long term, and completely minimize the manifestations of the disease. These are, again, sedatives, antipsychotics, tranquilizers. The treatment of manic-depressive psychosis also often involves the use of lithium carbonate: it has a pronounced anti-manic effect, removes the excited state.

Psychotherapeutic methods of treatment

Although medications play a huge role in the recovery of a person with bipolar disorder, other therapies are needed. Including the need for a person and psychological help. The following are widely used in this regard:

• Cognitive therapy. At this stage, a person needs to find out what in his behavior aggravates his condition. This will help avoid similar patterns of thinking in the future.
• Family therapy. Helps in establishing contacts with other people, especially with relatives and friends.
• Social therapy. It involves, first of all, the creation of a clear daily routine, which will allow you to regulate the time of work and rest, not allowing you to overstrain unnecessarily or worsen the patient's condition in any other way.

General therapy

In the intervals between depressive and manic phases, conservative treatment methods are used that contribute to relaxation, mood stabilization and overall strengthening of mental and physical health. Electrosleep, physiotherapy, massage, hydromassage, etc.

In conclusion, it is worth noting that although manic-depressive psychosis is a rather dangerous disease for a person, if treatment is started in a hospital on time, the patient may well return to normal life. And of course, in addition to medicines and procedures, the support of loved ones is very important in this situation. The same applies to illnesses such as depression or hypomanic psychosis.

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 disease sometimes goes unnoticed, and its manifestations are often confused with other mental disorders. Isolated forms are less common, but if they are found, then with a pronounced depressive episode, such patients are diagnosed with endogenous depression. And with a manic syndrome - the diagnosis includes a wide range of mental disorders, this also includes schizophrenia. There is also a mixed form, which is characterized by a rapid alternation of mania and depression, it is for 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 a depressive-manic syndrome.

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

• Personal characteristics. The so-called manic personality type: a person is confident in his rightness, pedantic, responsible, 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 trouble;
• Stress (physical or mental abuse, strict upbringing);
• Injuries of 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, it can be concluded that the female half of the population has 1.5 times more patients with TIR than men. The risk of getting sick increases if a woman is experiencing severe stress, is in the postpartum or premenopausal period. The peak of the disease usually falls on 20-30 years, which also makes it difficult to diagnose it in advance. By the end of the 20th century, the number of people with TIR reached 1%, and of these, 0.3% have a severe course.

In adolescents, TIR develops imperceptibly, the symptoms are mistakenly accepted by others and parents as a manifestation of character (depression, unwillingness to communicate with anyone, or vice versa, motor and speech excitement, 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 has only:

Periodic mania;

Periodic depression.

• Bipolar. There is an alternation of these two symptoms.

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

• Properly interlaced. Depression and mania alternate with each other, and there are light intervals between episodes;
• Wrongly interleaved. 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 is one big episode, there is a light gap before the next symptom complex;
• Circular. The alternation of depression and mania is constant, and there are no inter-attack light intervals.

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 depression to mania ratio of 3:1. A clear period in the form of 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 TIR is.

Hypomanic psychosis is characterized by an increase in vitality, an improvement in thought processes, and an increase in physical activity. A person in this state walks “like on springs”, enjoys minor trifles, the need for sleep decreases. This phenomenon is called tachypsychia. The hypomanic state lasts about 3-4 days.

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

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

The depressive phase includes bradypsychia, which is mental retardation, a painful decrease in mood, and a decrease in motor activity. In patients, appetite disappears, the need for sexual intimacy disappears, 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 TIR, which will allow differential diagnosis with depression).

Types of depression in TIR

For MDP depressive form, several types of depression are characteristic:

• Simple. It is characterized by low mood, decreased physical and mental activity. That is, it represents the triad of classical depression;
• Hypochondriacal. In addition to a depressed mood, the patient experiences fear for his health, an anxiety-phobic disorder joins. Especially common is carcinophobia - the fear of cancer;
• Delusional. In addition to the classic triad, there is the presence of hallucinations, 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, a delusional disorder in the form of a delusion of guilt is characteristic;
• Anesthetic. Inability to feel anything, patients complain of "emptiness inside."

The depressive symptom itself can be both with somatic and without somatic manifestations. In the first option, patients may complain of headaches, discomfort in any part of the body, feeling of a lump in the throat, difficulty breathing, heaviness behind the sternum.

All people with some form of depression are prone to suicidal attempts, so they must be carefully monitored.

Diagnostics

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

An examination of the brain is carried out to detect an organic lesion (MRI) and / or perversion of the conduction of nerve impulses (EEG). A conversation with relatives about the health of a sick person is desirable, since, often, there is no criticism of their condition in such patients.

In order to make a diagnosis of manic-depressive psychosis, at least two episodes of mood disturbance must be present. And one of them must be a manic syndrome. The correct interpretation of the clinical picture, comparison with risk factors, with heredity, with instrumental and laboratory methods of research, and passing by the patient a number 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 arising as a result of a neurological or other somatic disease.

Treatment

Severe forms of manic-depressive psychosis are considered exclusively in a psychiatric hospital. With a mild or moderate form, outpatient treatment is possible, subject to the adequacy of the patient. Therapy differs depending on the phase of the disease. With depression - antidepressants and mood stabilizers. With manic syndrome - normotimics. If the TIR is severe, then antipsychotic drugs are used. Additionally, conversations are held with a psychotherapist and / or a psychiatrist, it turns out the reason that led to the development of TIR. In children and adolescents, it is necessary to exclude juvenile schizophrenia, attention deficit hyperactivity disorder (a number of tests are carried out that will allow a correct diagnosis). In the depressive phase, occupational therapy, engaging in a favorite hobby is recommended. With manic - 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 TIR, it is necessary to isolate oneself from stressful effects - 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 medication prescribed by a doctor to smooth out the picture of TIR. With the systematic use of drugs, the risk of a new affective disorder is significantly reduced.

Forecast

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

This mental illness is known to the broad masses of people under different names. We are talking about manic depression, which has recently become more common.

The frequently used term "manic depression" refers to bipolar affective disorder and manic-depressive states, accompanied by a complex of symptoms with clearly defined, alternating phases of mania and depression.

This condition is accompanied by increased emotional lability (unstable mood).

Manic depression. What it is?

This is an endogenous (based on hereditary predisposition) mental illness that manifests itself in such phases (states):

1. Manic.
2. Depressive.
3. Mixed.

In this disease, the patient undergoes a sharp change of phases. A mixed state is characterized by a combination of different symptoms of this disorder. There are a variety of options for this phase.

Manic-depressive disorder often takes severe and pronounced forms. It requires mandatory professional therapy or correction.

Who suffers

Until today, there is no common understanding of the boundaries and definitions of this type of mental disorder in psychiatry. This is due to its pathogenic, clinical, nosological heterogeneity (heterogeneity).

Problems in accurately assessing the prevalence of manic depression are due to the variety of its criteria. So, according to one estimate, the proportion of sick people is about 7%. With a more conservative approach, the figures are 0.5-0.8%, which is 5-8 patients per 1000.

The first signs of such conditions are typical for young people. At the age of 25-44, about 46% of patients suffer from this disease. After age 55, bipolar disorder occurs in 20% of cases.

This disease is more common in women. At the same time, depressive forms are more characteristic of them.

Very often, patients with MD (about 75% of cases) also suffer from other mental disorders. This disease is clearly differentiated (distinguished) from schizophrenia. Unlike the latter, manic depression of any severity practically does not lead to personality degradation.

A person suffering from bipolar disorder most often realizes that something is happening to him and goes to the doctor.

Bipolar disorder in children

This disease in childhood is much less common than, for example, schizophrenia. In this case, most often there are no all the manifestations that line up in a typical picture of manic and depressive attacks.

Manic depression in children over the age of 10 is quite common. It is the most pronounced. In practice, typical cases were noted even in children of 3-4 years of age.

One of the main features of bipolar disorder in children is more frequent seizures than in adults. They are reactive. Experts note that the smaller the child, the higher the likelihood of a manic, rather than a depressive nature of bipolar disorder.

Symptoms

Manic depression is a disease in which a person has a depressive-anxiety state. Most of the time, anxiety is unfounded.

This disease can be easily distinguished from melancholia. Patients withdraw into themselves, speak little, and are extremely reluctant to talk with a doctor. A person with a symptom of anxiety cannot tolerate long pauses.

Patients also show various health problems. They manifest as lack of appetite, bradycardia, constipation, weight loss, chronic insomnia. Such people often generate delusional ideas and express suicidal thoughts.

The patient is identified by a shifty look, constantly moving hands. At the same time, he constantly corrects or pulls something. His posture changes frequently.

Severe cases appear in 2 stages:

1. Loss of control.
2. Numb.

In these cases, you need to call an ambulance and hospitalize the patient in a special medical facility. In this state, a person is capable of terrible deeds.

Phases

In bipolar disorder, affective states, called phases, alternate periodically. Distinguish between them and "bright" periods of mental health. They are called intermissions. At this time, even after a long illness and many different phases, the mental functions of a person practically do not decrease.

During the period of intermission, personal qualities and the human psyche completely restore normal functioning.

The manic phase of bipolar disorder is characterized by the following features:

• too excited mood;
• talkativeness;
• high self-esteem;
• a state of euphoria;
• motor excitement;
• irritability, aggression.

The manic phase is replaced by a depressive phase, which is characterized by:

• a state of melancholy, sadness, apathy;
• anxiety, anxiety;
• feeling of hopelessness, emptiness;
• loss of interest in favorite activities;
• guilt;
• lack of concentration and energy;
• intellectual and physical retardation.

If a person has several signs of a manic-depressive symptom complex, it is necessary to immediately contact a psychotherapist, psychologist or psychiatrist. Without the necessary drug treatment and psychocorrection, the patient may develop severe forms of this disease.

Treatment

With bipolar disorder, treatment of the patient is required. It should be carried out by an experienced specialist, since cases of remission of this disease are not uncommon.

As a rule, MD therapy is carried out in stages. At the same time, the following are carried out:

1. Medical treatment with special preparations, selected individually. In case of lethargy, agents that stimulate activity are prescribed, and in case of excitement, they calm the nervous system.
2. Electroconvulsive therapy in combination with special diets and therapeutic fasting.
3. Psychic correction.

Forecast

Provided that the patient has only a manic-depressive syndrome without concomitant diseases, the patient responds well to therapy. After a short time, he can return to his normal life.

The most effective treatment is when a person contacts a specialist after identifying the first signs of bipolar disorder.

Advanced forms of this disease can lead to irreversible personality changes. In this case, the therapy will be very long and often ineffective.

Manic depression is not a "sentence" for a person. Timely treatment can return the patient to normal life in the vast majority of cases.

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