A Consultant Psychiatrist and Head of the Psychiatry Department, University of Benin Teaching Hospital, Edo State, Dr Israel Aina, speaks to GODFREY GEORGE about the management of bipolar disorder
W hat is bipolar disorder?
It is a mood disorder. It is a disorder that affects people’s moods and feelings. In this kind of disorder, you would have an individual with two episodes of mood. One of those episodes would be that of mania in which the person is excessively happy. On the other hand, the person may experience depression. It is also possible that the only mood the person experiences all the time is mania. All the same, the condition still qualifies as bipolar affective disorder.
In mania, as I said, the person is excessively happy all the time, beyond measure, or the person could be excessively angry, beyond measure. The person would also have so much energy than usual and would think more highly of himself than he should think. Simply put, in mania, the person is either excessively happy or excessively angry. In other variants, the person may have one episode of mania and at other times, exhibits features of depression.
What causes this condition?
Like many other mental illnesses, the causes are multi-factorial. Many things add up to bring about the illness. One common causative factor is changes in the chemicals in the brain. There are some chemicals in the brain that when they become deranged, they can cause a person to come down with the features of this condition. The features would be determined by what part of the brain that is affected. Mania is sometimes connected with dopamine activities in the brain. Depression, on the other hand, is associated with something like serotonin. These are chemicals in the brain. Apart from those, there are other associated factors, such as the stress of everyday life, which is enough to make people break down and slip into either depression or mania.
When people go through the difficulties and stress of life and they find it hard to cope, then the person may have a psychological breakdown. What Mr A can cope with, Mr B may find it difficult to cope with. There are a lot of things embedded in this kind of stress. It could be problems in the family, problems in marriage, problems at work, problems of accommodation and inter-personal relationships and so on.
What are the clinical features signposting bipolar disorder?
People should look out for features of mania or those of depression. Someone who is perennially unhappy may be dealing with depression. For such a person, things that ordinarily would cheer people up do not cheer them up. You’d notice they are consistently unhappy. The unhappiness is just there in spite of anything. It doesn’t change. The person may also feel tired all the time; these are episodes of low energy levels even though the person may have eaten and rested very well.
The other thing you’d find is that the person does not have interest in the things they used to be interested. There are things that everybody would enjoy to do; but that person would just be perpetually withdrawn. Then, we would say there is loss of interest in otherwise pleasurable events, such as sports or music, that they used to enjoy. The person does not enjoy them anymore. The person may also avoid social media. The person may even find it difficult to eat, and over time, there would be weight loss. There would be episodes of repeated insomnia. They would also find it difficult to concentrate and complete tasks. When all of these come together, then we may say the person has depression.
In mania, there would be a mood problem where one is unduly happy or unduly angry. The person could have, in addition to that, excessive energy that will make him think more highly of himself than he should. A person who has mania would also have problems with sleep. The difference is that the sleep problem with the person who has mania is that they think there is no problem because they have so much to do. Unlike depression where the person is struggling to find sleep, in mania, you would see that these people are so busy and hardly have time to complete any task or even to sleep. It is the family and friends who would often notice that the person is not sleeping and begin to worry.
The one hour or so of sleep that they get, they do not even let it extend because they’d remember they have a lot of things to do. The person may also begin to eat excessively because of the increased activities. They may not add weight because the energy is burnt very fast. Over time, the person is not able to go and do their daily activities because of bottled-up anger and energy. When they try to do many things at the same time and are unsuccessful because of the confusion, they become angry and may begin to have issues with everyone around them. These are some of the things to look out for.
Are there types or stages of bipolar disorder?
The stages would be the episodes. Mania and depression may be of different intensity. The mania could be less, in which case the person is not so much disturbed and they can still work and get along with people, but may get angry easily. That is the feature there. That is called hypomania.
For the full-blown stage, we say it is mania. This is the same for depression. The person may have mild, moderate and severe aspects of depression.
At what point does one’s personality trait interface with this condition?
Personality issues are, in their own right, some form of mental disorder. They can also be referred to as personality disorders. People have various tendencies to have different ways of life. It is very difficult to say this is a personality type for bipolar disorder. This is because the personality issues that people may have cut across different facets. But to go by the books, it would be considered that those who are, at one time, extroverted, and at another, introverted, may have the tendency to develop this kind of condition. People, who at one time appear to be very outspoken may have a trait that may look like mania. Those who tend to be too withdrawn, that people say are introverted, may have features that may eventually look like depression. But those associations are not very clear and we cannot be very absolute about them.
What should be one’s response when diagnosed with bipolar disorder?
The easiest thing to do is to seek help from a professional so that you are in a safe and good place. There are a lot of problems that can go with this condition if they are not taken care of on time. The person who gets very angry may go out of his way and become very aggressive and destructive. This may lead them to harm or even kill another individual. These are very bad situations that can come out of mania. When one begins to see these traits, one should seek help from a professional. For depression, one can begin to have suicidal tendencies and may eventually die by suicide. If one notices a family member or friend acting this way, they need to quickly advise them to seek help so treatment can be given and management can start.
What is the usual approach by the medical practitioner towards diagnosing bipolar disorder?
The primary thing to be done is to take a history to trace the development of the matter, which may be given, most times, by the family or friends of the person that has been presented for diagnosis. This person may not be able to give their own story clearly except the condition has not become severe. So, most times, you depend solely on the history or story told by the family and friends of the individuals. It is from this history that we can bring out the salient points used to make the diagnosis. After the history, we would do a mental state examination. Here, one would assess the way the person’s mind works and the mental state. There are a series of tests that we do, questions that we ask, together with the history that we have taken to arrive at these diagnoses.
Diagnoses are not done by running laboratory tests. Mental disorders are not blood or urine problems. They are problems in the mind, which are only seen when you hear a person talk and when you see the person act. Possible laboratory tests that could be done would be because the health care professional may want to give them drugs.
Is this hereditary?
Yes, it can be hereditary. I would like to add that stigma or labelling them as ‘mad men or women’ would not solve the matter. Help them with a lot of comforting words and support for them to heal properly.
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.
Contact: [email protected]