Bipolar Affective DisorderMuktesh Daund
One fine afternoon after drizzling, I was attending OPD (Out Patient Department) of my Post Graduation Institute. Suddenly Bonzo (Name changed) entered my room, Started speaking spontaneously, I was not able to interrupt talk of Bonzo. He was speaking continuously and fast. He was speaking on many issues, mixing them inappropriately, speaking beyond his limits. Speaking on politics. In between saying that, he is the Chief Minister of Assam.
When started talking about politics suddenly started saying, “I got supernatural power”. In between singing song. Suddenly started speaking in English, In between speaks Hindi; But not able to stop speaking. I had to listen to his speech forcefully, not only listen but I had to respond too. This was about his speech. Clothing was also a strange, dark colored shirt with missing two buttons. Half in-shirt, odd hairstyle. Wearing goggle on the forehead, also having two- three different colored sacred thread on a wrist.
And above all having big ‘Tilak’ on the forehead, which turned all his face into red color and in this condition shouting “Om Namah!… Shivay…” continuously, entered my OPD. He was not seated on the chair rather pacing in available space. All the people in the waiting area started looking at him. He was laughing loudly and doing some gestures. Using abusive words towards family members. Saying that they brought him in OPD by cheating. Even threatening to me also, saying “If you give me some medication or injectable, I will file a case against you.”
After listening about some time we gave him injectable, forcefully with permission of family members and somehow helped him to get some sleep. Because last three to four days he did not sleep. All day keep roaming in the village, keep talking with people, whether he knows them or not. Keep arguing with people on trivial issues. These changes started in the last seven to eight days. But he was not willing to visit a doctor. Family members with help of other five-six villagers brought him to OPD. Then I started collecting history of illness from Father. He said, “Doctor he was never like this, rather happy go lucky not much communicative, loving his work and study, used to listen to me, but now not listening to anyone. Even sometimes showing physical aggression too, whoever argues with him”
“Not only this but, now he started giving orders to us, like how to behave? How to speak to him? Not able to sleep at night, keep listening to songs at night with full volume on the music system. All neighbors are disturbed because of this. Not taking proper care of himself, not bathing, not taking food saying that with less food he can manage all things, so why to waste time in eating more food. Also not studying at all.”
Now tell us, doctor, “what happened to him?”
After detail history, I told him that, in my opinion as per standard diagnostic systems “He is suffering from Mania.”
He didn’t understand; I assured: “Don’t get confused, I will tell you in simple words.”
During a manic phase, a person may feel very happy and have lots of energy, ambitious plans, and ideas. He may spend large amounts of money on things you can’t afford and wouldn’t normally want.
Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of this phase. So Mania is extreme happiness. Which is in excess and abnormal as per the situation.
It’s one of the severe condition in Psychiatry, But easily controllable with appropriate and adequate medication from an eligible person.
In this condition, there are changes in levels of functioning of different brain areas and Neurotransmitters (Chemical messengers in the brain). Mainly increase in levels of dopamine and serotonin. Not only this, but it may have genetic contributions, not related to one gene but many in complex ways. It is observed that it will occur more commonly in Families which are having a person with a similar illness.
To get Happiness is the ultimate goal of life. Who will not like to be happy? Rather be happy is basic fundamental need of all human. Everyone must get this, but when it became excessive, pervasive and problematic called as a Mania, which is a disorder. And once anyone developed this Manic episode, He may become problematic for himself, family and to society. No one can predict, what a person with Mania will do.
There are different explanations, why it occur. Biological I told you earlier, some psychoanalytic explanations are also there. Everyone knows that when anyone feels sad, he will cry, rather he should vent out his emotions. Its natural process. As per Psychoanalyst view once sadness became excessive, and that fellow is not able to control it, then he may start laughing and speaking whatever is there in his mind. Whatever he didn’t get or not able to get. He starts creating a virtual world. In that world, he starts behaving as if he got all those missing things in his life. He gets so much involved in that world, that he is not able to control his thinking and action. And this condition manifests as Mania.
If mania is associated with joy, the patient may laugh, play, dance night and day, and go to the market crowned as if a winner in some contest of skill. The ideas the patients have are infinite. They believe they are experts in many fields e.g. Astronomy, philosophy, or poetry.
The person may become excitable, suspicious, and irritable; they might get noises and buzz in the ears; or may have visual hallucinations; bad dreams and his sexual desires may get uncontrollable; easily get aroused to anger.
When only one such kind of episode occur, we called it as Mania. But if it occurred again then we call it as “Bipolar affective disorder”. In Bipolar affective disorder, there are more than one episode of Mania or in between having episode of Depression.
So, question comes, what is this Depression? This is somehow reverse picture what we discussed in Mania. This is primarily characterized by predominant low mood, not able to enjoy things which was previously enjoyable, and easy fatigability.
The term low mood refers to not feeling good as per situation. Anyone can feel sad, but if it persists for most of the day and for many days ( more than 14 days) then it is something serious. In this situation person is less communicative, avoiding social gatherings, frequent crying episodes may be there, thinks that he is failure.
Unable to enjoy things which were enjoyable previously, like watching movies, gardening, morning walk, even hobbies he finds no more enjoyable. Not only pleasurable things but he is not able to feel any emotions. May stop doing daily activities, spending most of time seating alone with blank stares.
Sometimes become restless, getting annoyed on trivial issues. Complaining of forgetfulness, we call it as pseudo dementia because actually he is not having memory problem but secondary to his poor attention and loss of interest he is forgetting things. Sometime speaks like, he did nothing in his life, he is not worth to live on earth and even if manage somehow there is no future for him, we called it as Hopelessness. If this hopelessness increases too much there are chances of Suicide, person secondary to his depressed thought may attempt to finish his own life. So whenever you found these kind of people ask them about any suicidal plan. There is one more misconception that asking about suicide increases chances of committing suicide. But research done on this topic and they found that it is worth to ask about suicide, it helps that person a lot for prevention of such disastrous thought.
Not only these psychological symptoms but many physical symptoms associate with depression like decreased or increased sleep. Complaining pain at multiple body site, decreased appetite. Secondary to these, marked weight loss. Generally weight loss is more than 5 % of body weight in one month. Sexual desire of that fellow is also decreased reverse to Mania in which it increases. These people generally feel more depressed in morning, we call it as Diurnal variation, means in one day symptoms changes. Also seasonal variability can be there, people feel more depressed generally in winter season when there is less light and short day compared to summer season.
In most cases these episodes can come in alternate way. This Mania-Depression we called it as Bipolar affective disorder. It is most interesting as well as problematic thing in Psychiatry. Because when person is in Mania, he will create some problem and brought in the notice of Psychiatrist; but when he is suffering from Depression, family member generally miss this finding and it may lead to Suicide. On one side I am the unique, no one can compete me, I can do many things in life. And on other side, I am not worth of living, my future is black. Person keep changing in these opposite poles. And he is not able to manage balance between these condition and because of it not able to live normal life.
Very often we miss less intense conditions, we called it as Hypomania. But these hypomanic cases are more common in Society. Especially during election campaign, festivals, marriage ceremonies. During these conditions some people start showing above mentioned symptoms, in milder format. Some of them may develop severe symptoms and come to notice of Psychiatrist.
Some people classify Bipolar affective disorder in type 1 and 2 according to presenting symptomatology. In type 1, this consist of depressive episode plus manic or mixed episodes. In type 2, depressive episode plus hypomanic episode.
Sometimes if these kind of episodes occur more frequently then it is called as Rapid cycling bipolar disorder. It generally consist of 4 or more episode of Mania, Hypomania, mixed or depressed episode in one year. Persons who experience subsyndromal manic-depressive mood fluctuations over an extended period without major mood episodes these are diagnosed as Cyclothymic disorders.
Mania is more common in Females. The girl who is living sober, not much communicative, always doing her study and suddenly if She start speaking more. Talking about philosophy, excessive and impossible planning, staying awake late night and singing song, started wearing more colorful dresses, started applying excessive makeup, repeatedly seeing in mirror, laughing excessively, started doing shake hand to unknown people. Then this is we should keep in mind.
Surprisingly these disorder can occur in children too. Child may present with psychomotor agitation, Pressure of speech, reduced sleep, Anger & temper tantrums, Irritability, Elation, Poor concentration, Increase in social activity, Talks loudly mainly the complaints of their parents.
Bonzo’s father convinced about problem his son is having, and willing to keep him in contact with Psychiatrist.