The article Pharmacological Treatment of Adult Bipolar Disorder by Baldessarini et al. focuses on the treatment of bipolar disorder, including mania. The authors describe the progress that has occurred in treatment over the past decades. However, some difficulties in considering approaches to the problem remain. These difficulties include lack of integration of the overall clinical picture in the treatment of bipolar disorder, abuse of antidepressants. Moreover, the article noted the fragmentation of the approach to individual manifestations of the disease, such as mania, depression and anxiety.
This article was selected due to its extensive contribution in raising practitioners’ awareness and skills regarding concurrent disorders and describing practices for screening and assessment of such disorders. The authors reveal the problem of treating mania and depression, manifested in the clinical picture of bipolar disorder. From a clinical and prognostic point of view, the most preferable is the classification of bipolar disorder, depending on the predominance of one or another pole of manic-depressive symptoms in the clinical picture. On unipolar variants (manic or depressive), bipolar with a predominance of (hypo)manic or depressive phases, as well as clearly bipolar, with approximate equality of phases.
Bipolar disorder, known as bipolar affective disorder and formerly as manic-depressive psychosis, is a set of mood disorders characterized by marked fluctuations in mood, thinking, behaviour, energy and ability to perform daily activities (Kato, 2019). People suffering from this disorder alternate their state of mind between mania or hypomania – a phase of joy, exaltation, euphoria and grandiosity and depression, with sadness, inhibition and ideas of death. The causes and development mechanisms of bipolar affective disorder are not yet completely clear, although recently significant new data have appeared in this area, primarily on the nature of the inheritance of susceptibility to the disease and its neurochemistry.
In addition, studying the action of antidepressants and other drugs at the level of nerve cells allows a deeper understanding of the pathological processes underlying bipolar disorder. All these data allow looking at the role in the development of the illness of previously established metabolic disorders of biogenic amines, endocrine changes, changes in water-salt metabolism. It causes pathology of circadian rhythms, the influence of gender and age, and constitutional features (Atkins, 2021). The hypotheses based on these data describe not only ideas concerning biological essence of the disease. Practitioners working in the field can also benefit from this information because it explains the role of individual factors in the formation of the clinical features of the sickness.
The symptoms of bipolar disorder can be similar to other types of illness, making it difficult for a doctor to diagnose. People with bipolar disorder often suffer from substance abuse, anxiety disorders, and even eating disorders. They are at a higher risk of developing thyroid disease, heart disease, and diabetes. Manic episodes are characterized by extreme highs that can make a person feel like they are on top of the world, with incredible energy, racing thoughts and mood swings.
During a manic episode, people may engage in hazardous behaviors, including risky sex, spending money, and using drugs. Severe cases of mania can cause a psychosis that will match the person’s mood (Baldessarini et al., 2019). A less severe type of mania is called hypomania, which can manifest as a time when patient feel good, and his mood improves, but it does not get out of control. Some people have only hypomania and never full mania, but for some, hypomania can easily turn into mania or depression without any warning.
Bipolar disorder is one of the few mental disorders in which drug treatment is indicated in all cases, and psychotherapy is an auxiliary tool. This disease is incurable, but its diagnosis and treatment is extremely important. Treatment can reduce the number of episodes, their severity and intensity, as well as prevent negative life events, help prevent relationship breakups, job loss, and even suicidal attempts. Thus, the quality of life of a patient with bipolar disorder who is undergoing treatment will be several times higher than that of a person who neglects treatment.
A wide range of antidepressants can be used to control depressive episodes of bipolar disorder. However, their use should be monitored very carefully, as some patients turn from depression to mania when treated with antidepressants. In other words, an antidepressant used to control depression can cause mania. In contrast, some patients who take antidepressants do not experience a switch to mania, but instead they feel worsening depression or more depressive episodes. For this reason, regular and subsequent communication with the doctor is necessary so that the prescribed treatment does not aggravate the general condition.
Antipsychotics were originally developed as a treatment for hallucinations and delusions in schizophrenia. However, major tranquilizers have been shown to have specific anti-manic properties even in patients without evidence of psychosis (López-Muñoz et al., 2018). Neuroleptics are often prescribed for a manic episode and may be helpful in cases of disorganized behavior, confused thinking, as well as hallucinations. A common property of these drugs is the ability to block the receptors of a neurotransmitter called dopamine. Too much dopamine in the brain can contribute to manic symptoms.
Standard practice after recovery is to reduce the dose of the antipsychotic. Some patients begin to experience manic symptoms soon after the dosage is reduced. In this case, they are prescribed antipsychotics on an ongoing basis to contain the relapse of mania. Therefore, antipsychotics can be considered as the drugs of choice for the treatment of acute mania, as well as drugs for the prevention of mania and psychotic symptoms.
These drugs can often cause side effects that worsen their tolerability. At the beginning of the course of treatment with such drugs, patients may experience muscle stiffness, tremors in the limbs, sometimes restlessness, restlessness and agitation. Long-term use of typical antipsychotics is often associated with a potentially irreversible side effect known as tardive dyskinesia. The disease is characterized by repetitive, involuntary, aimless muscle contractions, especially of the tongue and facial muscles.
Anxiety is a symptom that often accompanies episodes of depression and mania. In addition, sleep problems are characteristic of depression, hypomania, and mania. Among the tranquilizers used in the treatment of the disease, benzodiazepines are the most common. They are used to quickly reduce anxiety and insomnia. Benzodiazepines may control early symptoms of hypomania. All these drugs can cause addiction, physical and psychological dependence, especially when taken uncontrolled.
Thus, the information from the article can affect my practice and the practice of people working in the field in a variety of ways. It provides detailed information on the symptoms of bipolar disorder, types of treatment, and the responses to the treatments. Bipolar affective disorder is treated on an outpatient or inpatient basis. At the peak of depressive episodes, when there is a risk of suicide, as well as to reduce the timing of the selection of pharmacotherapy, treatment should be carried out in a hospital. If left untreated, bipolar personality disorder can progress and cause a deterioration in quality of life. Untreated bipolar disorder inevitably leads to family conflicts, alcoholism or drug addiction, social degradation and, ultimately, suicide. With the right treatment for bipolar disorder, it is possible to stabilize a patient’s psycho-emotional state and eventually achieve remission.
References
Atkins, C. (2021). Praise for co-occuring disorders (2nd ed.). PESI Publishing.
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198-217. Web.
Kato, T. (2019). Current understanding of bipolar disorder: Toward integration of biological basis and treatment strategies. Psychiatry and Clinical Neurosciences, 73(9), 526-540. Web.
López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International Journal of Molecular Sciences, 19(7), 2143. Web.