Does depression have a sister called bipolar disorder?

With the popularization and promotion of psychological knowledge in recent years, I believe everyone has learned a lot about emotional diseases such as depression. In daily outpatient clinics or online consultations, people often come to see a doctor or consult because they are depressed and want to know whether they suffer from depression?

When I tell them that the preliminary diagnosis may be "bipolar disorder" after detailed consultation and evaluation, many people will be surprised: "Bipolar disorder?" What the hell is this? ”I usually jokingly say, "It's a 'hybrid ghost.' ”It's called "mixed" because bipolar disorder usually has manic or hypomanic episodes in addition to depressive episodes.

What is bipolar disorder?

Bipolar affective disorder (BD) is a common mood disorder characterized by both manic or hypomanic episodes and depressive episodes. Manic episodes are characterized by elevated mood, increased verbal activity, and high energy, while depressive episodes are characterized by low mood, loss of pleasure, decreased verbal activity, fatigue, and slowness [1]. The clinical manifestations of bipolar disorder are very complex. Low and high moods alternate and appear irregularly. It is also accompanied by anxiety, obsessive-compulsive disorder, substance abuse, etc. Psychotic symptoms such as hallucinations, delusions, or catatonic symptoms may also occur, accounting for almost half of the manifestations of mental disorders. Therefore, it is not an exaggeration to say that it is a "hybrid ghost".

Patients with bipolar disorder will fluctuate into varying degrees of extreme emotions, wandering between the two opposite sides of mania and depression, with their moods sometimes reaching the sky and sometimes sinking into the ocean. Many patients with bipolar disorder "sympathize with each other" and tacitly call themselves "roller coaster players". However, the ups and downs of emotions like a roller coaster are making their lives turbulent. When in a manic state, they can stay up for days and nights, are highly excited, and can continue to work, create, etc. Among patients with bipolar disorder, there are many artistic and scientific geniuses such as Van Gogh, Nietzsche, Beethoven, and Goethe. Many people are obsessed with efficiency and self-confidence during a manic episode, mistakenly believing that suffering from bipolar disorder is a symbol of "genius", and are unwilling to seek medical treatment. However, this state is unsustainable and seriously affects people's physical and mental health. The inspiration and creativity during a manic episode may be short-lived. Some patients who vowed to become a "leader" in a certain industry one month will become sluggish and stay at home without even leaving the house the next month.

Because manic and depressive episodes occur simultaneously in a person, "bipolar disorder" once had other names such as "cyclothymia," "manic-depressive psychosis," and "manic-depressive disorder." In 1980, the American Diagnostic and Statistical Manual of Mental Disorders (DSM) adopted the diagnostic name "bipolar disorder" and it is still used today. According to the characteristics of past and current episodes of the disease, in the American Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) released in 2013, bipolar disorder is divided into seven subtypes: bipolar disorder type I, bipolar disorder type II, cyclothymia, substance or drug-induced bipolar and related disorders, physical disease causing bipolar and related disorders, other specific bipolar and related disorders, and non-specific bipolar and related disorders. ； ICD-11 mainly divides bipolar disorder into bipolar disorder type I (bipolar disorder type I, BD-Ⅰ), bipolar disorder type II (bipolar disorder type II, BD-Ⅱ) and cyclothymia.

The mental health survey plan launched by WHO in 2011 showed that the global lifetime prevalence rate of bipolar disorder is 2.4%, and there are about 8.4 million bipolar disorder patients in my country. More than 1/3 of patients seek help within 1 year after the first definite clinical symptoms of bipolar disorder. Only 20% of patients with bipolar disorder are diagnosed with bipolar disorder within the first year due to depressive episodes, and the remaining patients have to delay the diagnosis for more than 10 years on average [2]. A survey in the United States shows that it takes an average of 10 years for patients with bipolar disorder to receive their first treatment after the onset of the disease, and more than 50% of patients have not received treatment for more than 5 years [3]. Therefore, the recognition rate, diagnosis rate and treatment rate of bipolar disorder are very low, which has an adverse impact on the difficulty of treatment and prognosis of the disease, aggravates the condition, and increases the economic burden of patients.

Determining whether a patient has bipolar disorder requires a comprehensive assessment, including:

1. Collect medical history at multiple levels

The collection of medical history comes from the patient's own narrative and the observations of insiders, including cross-sectional symptoms and longitudinal disease course.；

2. Physical examination and laboratory examination

There are currently no specific biomarkers for the diagnosis of bipolar disorder. For example, no blood or imaging test indicators can confirm bipolar disorder. The test results should be combined with the medical history to rule out emotional disorders caused by physical diseases or the use of psychoactive substances.；

3. Mental examination

It includes doctors understanding the patient's cognitive, emotional, volitional behavior and other mental activities through interviews, and observing the patient's appearance, behavior, speech and other performances in a natural state to understand his inner mental activities. Both are indispensable.；

4. Scale evaluation

The Young's Mania Rating Scale (YMRS) and the Bech-Rafaelsen Mania Scale (BRMS) are commonly used to assess mania. The 32-item Hypomania Symptom Checklist (HCL-32) and the Mood Disorders Questionnaire (MDQ) are commonly used to assess hypomania. The Hamilton Depression Rating Scale (HAMD), Montgomery-Eisenberg Depression Rating Scale (MADRS), and Self-Rating Depression Scale (SDS) are commonly used to assess depression. The Bipolar Index Scale (BPx) and the Clinically Practical DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) Depression with Mixed Characteristics Scale (CUDOS-M) can also be used to assess its characteristics.

Bipolar disorder includes 4 types of mood episodes: manic, hypomanic, mixed, and depressive episodes. The key points of the 4 types of emotional attacks are as follows:

1. Manic episode: two sets of symptoms listed below exist most of the time every day for at least 1 week: extreme mood states characterized by elation, irritability, and arrogance, with rapid changes between different mood states； Increased activity or subjective experience of increased energy. At the same time, there are several other clinical symptoms that are different from the patient's usual behavior or subjective experience: more talkative or urgent speech ； Wandering thoughts, quickened associations, or racing thoughts ； Overconfidence or grandiosity, which may manifest as delusions of grandeur in manic patients with psychotic symptoms ； reduced sleep need ； distraction ； impulsive or reckless behavior ； Increased sexual desire, increased social activities or purpose-oriented sexual activities, etc.

2. Hypomanic episode: Symptoms are consistent with a manic episode. The points of differentiation from a manic episode include: ① No psychotic symptoms； ②Not accompanied by serious impairment of social functions ； ③No hospitalization is required, and the duration of hypomania is specified in the DSM-5 as 4 days.

3. Mixed episode: Both manic and depressive symptoms are present and prominent most of the time every day for at least 1 week, or there is a rapid switch between manic and depressive symptoms.

4. Depressive episode: The key points of a depressive episode in bipolar disorder are the same as those in depressive disorder.

What are the causes and risk factors of bipolar disorder?

A large number of studies have proven that the causes of bipolar disorder are related to genetic factors, environmental factors and psychosocial factors. These three major causes can be said to be consistent with most mental illnesses. However, bipolar disorder has obvious familial aggregation. The probability of the disease in relatives of patients with bipolar disorder is 10-30 times higher than that of the general population. The closer the blood relationship, the greater the risk of the disease. Therefore, genetic factors play an important role in the cause of bipolar disorder.

Risk factors for bipolar disorder include:

age

Bipolar disorder mainly occurs in early adulthood, with most patients starting between the ages of 20 and 30. It is more common before the age of 25. However, in recent years, the standardization of follow-up diagnosis and treatment and the ability to identify it have improved, and the diagnosis of bipolar disorder is not uncommon in children and adolescents.

gender

The male-to-female ratio of bipolar disorder type I is about 1:1, but bipolar disorder type II and mixed types are more common in women. Premenstrual syndrome, postpartum depression, amenorrhea or polycystic ovary syndrome are among the risk factors for bipolar disorder.

season

The attack pattern of some patients with bipolar disorder may have seasonal changes, with depressive episodes occurring in early winter (October-November) and manic episodes occurring in summer (May-July).

Marital and family factors

Compared with the general population, bipolar disorder is more common among people who are divorced or living alone. The divorce rate of patients with bipolar disorder is more than three times higher than that of the general population. A good marital relationship may delay the onset of bipolar disorder, alleviate symptoms during an episode, and reduce the recurrence of the disease.

personality traits

People with cyclothymic personality and hyperemotional personality traits (obviously extroverted, energetic, needing little sleep) are prone to bipolar disorder.

substance abuse

Bipolar disorder has a high comorbidity rate with alcohol, nicotine, drugs and other substance abuse, which has adverse effects on bipolar disorder treatment such as increased non-compliance, more frequent attacks and hospitalizations, and decreased quality of life.

In view of the diversity, invisibility, and complexity of treatment of bipolar disorder, people with the above symptoms, genetic characteristics, and risk factors are recommended to seek professional help in time for early detection, early diagnosis, and early treatment. You can also read books such as "Bipolar Disorder—What You and Your Family Need to Know" and "My Thirty Years of Living with Bipolar Disorder" to learn more about bipolar disorder and to better live in peace with it.

(The article comes from the "Youlai Psychology" public account, follow it to get more popular science. )