The differential diagnosis of Bipolar disorder symptoms

Many of the bipolar disorder symptoms, spectrum of disorders can occur with other diseases, including disturbing disorder, psychotic disorders, personality disorders, etc.

Cyclothymia, first was described by K. Kahlbaum (1882), in its clinical manifestations in many ways similar to the path and the BTS over the bipolar disorder symptoms. According to modern view, it is defined as chronic affective disorder, characterized by blurring pronounced fluctuations in mood from hypomania to depression, never reaches the detailed criteria for BIPOLAR DISORDER SYMPTOMS-I and BIPOLAR DISORDER SYMPTOMS-II. There is a tendency to underestimate the disease because if developing depression and subjectively assessed as discomfort, illness or disease, hypomania usually perceived as desirable periods Well-Being.

For those patients is observed experiencing chronic cycle of disease during the many periods hypo maniacally or depressive symptoms, which never quite pronounced in order to meet the diagnostic criteria hypomania or depression. The minimum period of affective disorders needed for diagnosis in accordance with the criteria for DSM-IV, defines two years.

Up to date, there are no clear criteria to distinguish cyclothymiacs and hypomania. Most also can not distinguish between cyclothymiacs and normal condition. At the same time, even subsidy normal forms of bipolar disorder symptoms bear the risk disadaptation, forming comorbids disorders, drug addiction, alcoholism, drug addiction, which are the cause of seeking care at the remote stages of the main disease.

As you know, hypomaniacal condition, typical for BIPOLAR DISORDER SYMPTOMS-II, is not an accompanied by social dysadaptation patient and very rarely are the cause of a doctor. In doing so, patients subjectively evaluate such conditions as the feeling of full health, good tone, a normal working and do not talk about them as a painful period. For retrospective detection hypo maniacally states require targeted qualified ascertain anamnestic data in the inspection of the patient to seek medical assistance in connection with the current depressed state. In the absence of such a thorough diagnostic approach hipomaniya can be detected by chance during a planned inspection of many years after the start of the disease.

Its clinical manifestations of hipomaniya different from deployed manic states, only less expressivity symptoms. In accordance with current diagnostic guidelines for diagnosis requires that the duration of symptoms is at least 4 days, if that would not offer significant violations of the daily activities of the patient and does not lead to hospitalization. However, in practice, such cases are often seen as hipertimiya and did not get into the field of psychiatry.

Despite the fact that according to diagnostic criteria hipomaniya never matter of social dysadaptation, its timely diagnosis is crucial, as well as developing later in the BIPOLAR DISORDER SYMPTOMS high depressive episodes led to a significant decline in functioning, disability and higher suicidal risk. Late detection of hypo maniacally states led to a mistaken diagnosis of recurrent depression and inadequate treatment with antidepressants, which leads to weighting current BIPOLAR DISORDER SYMPTOMS and of itself, can cause the formation of FC(fast cycling).

Current diagnostic systems DSM-IV and ICD-10 are trying to divide schizophrenia and BIPOLAR DISORDER SYMPTOMS in categorical terms, bringing to the fore the presence or absence of symptoms to diagnosis. In fact, among the many patients with schizophrenia symptoms of depression and mania, but patients with BIPOLAR DISORDER SYMPTOMS are show shnaiderovschy symptoms of first rank such as delirium and hallucinations with depression. Some compromise on the issue of separation of BIPOLAR DISORDER SYMPTOMS and schizophrenia was the introduction of modern system of classification of disease schizophrenia disorder as a separate diagnostic category. According to ICD-10 main differential diagnostic feature schizophrenia disorder and a bipolar disorder symptoms with affective scenes in the structure which has noncompetitive passion psychotic symptoms, is the content of nonsense that should not meet the criteria listed for schizophrenia, as well as, with BIPOLAR DISORDER SYMPTOMS ravings should not is absolutely incredible content or culture inadequate, and hallucinations should not be commenting nature.

Availability comorobids troubling disorder or alcohol abuse may mask the presence of affective phases. Also in the FC during the BIPOLAR DISORDER SYMPTOMS without the development of heavy affective phases can be mistaken diagnosis of personality disorders, for example, emotionally labile or hysterical type. In all these cases require thorough diagnosis to identify circular affective phases.

Clinical recommendations for therapy fast-cycling current bipolar disorder (draft)

Path or, in the terminology of American researchers fast-cycling course (FC) is one of the most disadvantaged, disadopt difficult curable options and current BDS. In recent years, increasingly seen patients with BDS over, that is amenable to more than 4 episodes per year.

Since the E. Kraepelin, and so far intensively studied the factors contributing to the formation of BDS and the clinical picture of this version of the current BDS. In recent decades, focuses on the development of therapeutic techniques designed to break BDS and the formation of euthymic period for those patients who actively pursued and acquired at the present stage of particular importance to study and introduction of new effective drugs from this population of patients.

1 Part of Clinical recommendations

Diagnostic criteria and classification

The classification of ICD-10 definitions FC with BDS none. According to current expectations, and in accordance with the criteria for DSM-IV, FC, BDS determined during the development of at least four affective phases (high depressive episode, mania, hypomania mixed episode) over the past year. These affective episodes may be separated by either a period of remission duration of at least two months, or they may end inversion passion and development phase of the opposite poles.
In doing so, each depressive episode must have a duration of at least two weeks, each manic or mixed episode - at least one week every hypo maniacally episode - at least four days.

Epidemiology

BDS prevalence in the population, according to various epidemiological studies, ranging from 0.5 to 2% (average nearly 1%) (H.G. Hwu 1989; H.U. Wittchen, 1992; RMA Hirschfeld , 2002 etc.), BDS occurs during the approximately 1 out of 4 patients BDS , and according to recent epidemiological studies, even more - up to 40 % and differ from unfavorable prognosis and resistance to therapy (L. Tondo, 1998; MS Bauer, 1999; R. Kupka, 2003).
During the widespread use of antidepressants three-cycling many authors (DL Dunner, 1977; JH Greist, 1990, etc.) the continued growth of FC current BDS. Thus, according to J. Angst (1980), following the introduction into clinical practice, by using antidepressants and EST number of illness with bipolar disorder symptoms, increased in 4 times, with 16% of it's sample transferred more than 20 episodes. L.L. Altshuler (1995) showed that approximately a quarter of patients BDS surveyed by the American National Institute of Mental Health increased phase formation or BDS may be linked to excessive use of antidepressants. These figures are confirmed by other studies (TA Wehr, FK Goodwin, 1987; I. Goldberg, et al., 2001).

According to the R.M. Post (2004), based on the results of clinical survey of 674 patients with BDS, FC were observed in 42% of patients, ultrafast (more than 4 episodes per month) - at 26.8%, ultradian (more than 4 episodes of inversion phase of a week) - from 19.7 %.

Clinical signs and over

From the perspective of modern clinical opinion, it is advisable to provide two versions of the current BDS with FC - primary and secondary (GS Sachs, 2004), despite the fact that the DSM-IV is not enshrined the separation.
Primary BDS during a continuous shift of phases of different poles for at least four months. This should be excluded any factors inducing the development of mania or reinforcing cycle (receiving antidepressants or other drugs, common medical illnesses). Primary FC during the often difficult therapy and the use of drugs that enhance the cycle may worsen over the disease.
Secondary FC during shaped by factors that may play a trigger role in increasing phase formation.
In most such cases, BDS diagnosed as primary affective disease, and during the FC is a secondary due to medical or other health factors. Secondary FC during the often provoked the introduction or exclusion of factors that could destabilize affective scope or provoke a cycle. Some patients BDS with the FC Over shortly after the lifting of antidepressants observed the development of manic symptoms.
Most people BAR availability periods FC flow over the disease there are also times without them. For such patients, even in periods when a sufficient basis for the diagnosis of FC not, in comparison with patients who have never had FC, a significantly greater number of episodes, shorter periods times higher suicide trends (RJ Baldessarini et al., 2000 ; W. Coryell et al., 2003). The data allows us to consider periods of FC for a clinical marker of adverse individual projection.
FC over BAR, continuing for years, the exception rather than the rule.
As reasons for the malignant course of the disease can be: serve alcohol and other forms of abuse addiction, multiple sclerosis, brain injury, delayed mental development, hypo thyroidin, migraines, etc., as well as the factors that have a trigger in the development of affective instability.

These include, for example, include:

• sleep disturbance;
• EEG-pathology;
• abolition of nicotine;
• rapid lifting of lithium;
• use or removal of antidepressants;
• receiving certain medications;
• steroids (anabolic steroids); sympathomimetic (stimulants, caffeine, anticoagulant, bronhodilatory, anorectal medecine);
• reproductive hormones / blockers (Gonadotropin, oral contraceptives, testosterone, dehydroepiandrosterone, clomiphene, tamoxifen);
• muscle relaxant;
• triazobenzenediazepim;
• thyroxin;
• barbiturates;
• stressful factors (conflict / trauma, grief / success, the loss of support systems, circadian violations, seasonality, moving from east to west shift work, etc.).

With FC is observed low activity, especially in the application of lithium salts, poor capacity and clinical identity. The majority of these patients detected one or more comorobids disorders, including alcohol and other substance abuse. They have a very low level of social and labor adaptation, most of his life such patients spend in hospitals.
For patients with FC characteristic delay of disease with depressive phase, cyclic premorbids lines on the preponderance of women compared with men.
More frequent formation of FC flow from oligophrenic perso. With thyroid disease (RD Alarcon, 1985; RM Cowdry, 1983, etc.) and the discovery of their violations of EEG in including latent paroxysmal activity (AB Levy , 1988), can think of the possible contribution to the development dimension organically inferior soil, as confirmed by data MA Zvyagelskogo (1988).

Among the disadvantages of options FC is also ultrafast cycles (development of 4 or more affective phases within 1 month), ultradian cycle (more than 4 episodes of inversion phase during the week) and even ultra-ultrafast cycles with the change of passion throughout the day. (KG Kramlinger, RM Post, 1996), which is almost impossible to distinguish from persistent person extremely unstable mixed affective state. These and similar to the clinical picture «Alternating option» affective mixed state (OO Sosyukalo, 1988) and «mixed mania» (JM Himmelhoch, 1986) are fairly typical of phenomenological manifestations of phase with a continuous flow show unfavorable prognosis of the disease and very difficult to therapy.

The course of depression

Depressive phase represented opposite manic phase triad of symptoms:

-depressed mood (hypothymia)

-slow-thinking (bradypsychia)

-braked-locomotive

In general, BAR depressive more evident than manic states. During the depressive phase of allocating four phases.

Patients lost appetite, food seems tasteless ( «as grass»), the patients lose weight, sometimes significantly (15 kg). For women, for a period of depression disappeared menstruation (amenorrhea).

In a shallow depression marked characteristic of the BAR daily fluctuations of mood:

-feeling worse in the morning (wake up early with a sense of anguish and anxiety

-inactive, indifferent)

- by the evening several enhanced mood, activity.

With age in the clinical picture of depression increasingly took the anxiety (no motivational disturbing premonition that «something should happen», «internal strife»).

1 Initial stage of depression manifested blurred weakening of the overall mental tone, lower mood, mental and physical performance. It is the emergence of moderate sleep disorders in the form of hardship and suspend its superficiality. For all stages of the current depressive phase characterized by improving the general well-being and mood in the evening.

2 Phase is characterized by increasing depression has a clear decline in sentiment with the emergence of disturbing component, a sharp decline in physical and mental efficiency, motor braked. This slow, laconic, quiet. Sleep disturbance resulting in insomnia. It is a marked decrease in appetite.

3 Stage pronounced depression - all symptoms reach maximum development. Characterized by severe psychotic affects anguish and anxiety, painfully experienced by patients. This sharp deceleration, quiet or whispered, monosyllabic answers to the questions, after a long delay. Patients long can sit or lie in one position.

Suicidal attempts, and the most dangerous in the early stage and to withdraw from it when the background of sharp hypothymia expressed no motor braked.

Hallucinations and illusions rare, but they may be (mostly hearing), often in the form of votes, reporting hopelessness of the state of meaningless existence, recommending suicide.

4 Reactive stage is characterized by gradual reduction of all symptoms persisted for some time neurasthenia, but sometimes, on the contrary, there is some hyperthymia, volubility, high motor activity.

The course of manic phase of depression

Maniacal phase represented major triad of symptoms increased mood (hyperthymia), motor excitation, ideational-mental (tahypsyche). During the manic phase of allocating five stages.

1 Hypo manic stage is characterized by elevated mood, a sense of spiritual recovery, physical and mental vivacity. This exuberant, fast falls the number of semantic association with the increase of motor association (on the similarities and harmony in space and time). It is moderately expressed motor excitation. The attention distraction has increased. Is hypermnesia. Moderately reduced the duration of sleep.

2 Stage pronounced mania characterized by further increasing expressions of fundamental symptoms phase. Patients constantly joke, laugh, against the backdrop of what may be momentary flash of anger. Speech expressed excitement reaches degree jumps ideas. Expressed motor excitation, expressed distraction lead to the inability to maintain a coherent conversation with a patient. Against the backdrop of a reassessment of his own personality appear delusional ideas of grandeur. At work, patients build brighter prospects, are investing money in a dead-projects, projects insane design. The duration of sleep drops to 3-4 hours a day.

3 Stage manic frenzy is the maximum expressivity major symptoms. Sharply motor excitation is messy nature, these seemingly incoherent (in the analysis unable to identify the mechanical associative connection between the components of speech), consists of excerpts of phrases, individual words or syllables.

4 Stage movement is characterized by complacency reduction motor excitation against the backdrop of continuing high spirits and voice excitation. The intensity of the last two symptoms are also gradually declining.

5 Reactive stage is characterized by the return of all of the symptoms of mania to the norm and even a slight decline compared with a norm of mood, asthenia. Some of the scenes being expressed mania stage and manic frenzy of patients can.

Depression and alternatives

Bipolar Disorder Symptoms

There are different types of bipolar disorder symptoms of depression. It's cyclical depression in which the alternating manic and depressive episodes, it is called bipolar depression. In monopolar depression is very frequent, the only state without a manic depressive episodes. It is just dismal condition, it may be easy, moderate and severe. This depression is characterized by problems with appetite and weight, sleeping problems, chronic fatigue, the decline of power, problems with concentration, the feeling of its own futility, suicidal mood and even suicide attempts. Reactive (psychogenic) depression may occur when a particular event such as death of loved one or loss of employment, but it's not a real depression. Mental depression means "bad mood" and range from mild to moderate depression. Thus, there is a seasonal disorder, which often occurs among people of northern countries.

Many reasons affect depression including diet, excessive consumption of sugar, sugar substitutes, coffee, alcohol and "junk food" ( hamburgers, pizza, etc.), all of which create an abnormal mental state.

Depression can be a very serious disease. In severe forms of depression modern medicine can be a gift from above, especially if these people are inclined to commit suicide and still can not lead a normal life. There need psychotropic drugs and I never will not deny this. But now a lot of abuse of medication. While this herb is wonderfully can help in other cases.

Bipolar disorder symptoms

Bipolar disorder symptoms (manic-depressive illness) mental state, reflected affective state-manic (hypomania) and depressive as well as mixed states in which the patient symptoms of depression and mania at the same time (for example, strung with melancholy, anxiety, or euphoria with braked - the so-called unproductive mania), a rapidly changing symptoms (hypo) mania and (sub) depression.

For the first time as an independent mental disorder affective bipolar disorder was described in 1854 almost simultaneously by two french researchers J. P. Falret (called «circular psychosis») and J. G. Baillarger (called «insanity in two forms»).

However, it is E. Krepelin identified manic-depressive psychosis as a separate unit in 1986. Krepelin introduced for this disorder name manic-depressive psychosis, which is a long time, it was generally accepted, but are now considered outdated and scientifically incorrect, as this disorder is not always accompanied by psychosis, and not always with him, there are two types of phases (and mania, and depression). Moreover, the term «manic-depressive psychosis» is offensive and stigmatizations patients. Currently, for the mental disorder made more scientific and politically correct name «affective bipolar disorder», abbreviated as BAR. So far in psychiatry different countries and different schools in one state has no uniform definition and understanding of the borders of the disorder.

Etiology Bipolar disorder symptoms

Etiology affective bipolar disorder so far not clear. Basic theories that try to explain the development of the disease, two parts: the hereditary and autointoxication (breach of endocrine balance, disruption of water-electrolyte exchange).

The clinical picture Bipolar disorder symptoms

From the first affektive bipolar disorder accounts for more at a young age - 20-30 years. The number of phases, each of the patient, unpredictable - disorder may limit one phase (mania, and depression hypomania ) for a lifetime, can occur only manic, only hypomania or depressved phases or a change of right or wrong interleaving.