Diagnosis ICD-10 F 31 Bipolar affective disorder (disease treatment)

Bipolar disorder refers to a type of mental disorder characterized by frequent and unreasonable changes in emotional status. Affective disorders are characterized by mood swings from a state of severe depression to unreasonable euphoria. to begin treatment for bipolar disorder in the early stages of pathology development.

What is bipolar disorder in simple terms?

Mood swings are common to every person. Often the patient himself, his friends and relatives associate changes in states with increased emotionality, enthusiasm, and a hysterical character.

The danger of the permissible norm for significant mood swings is associated with the development of the diagnosis. Both the patient himself and his immediate family too often do not suspect the presence of a serious illness, attributing it to a strange upbringing or eccentric character. Frequent changes in mood can be taken as normal. Patients with bipolar disorder themselves try to cope with unpleasant manifestations, mistaking them for fatigue or mood swings.

As symptoms increase, patients experience a significant deterioration in quality of life, patients lose the opportunity to continue professional activities, and children’s school performance decreases. A common outcome is the development of suicidal tendencies.

It is possible to assume the presence of this affective disorder based on the level of changes in the emotional state, often reaching extreme levels. The manic (euphoric) stage is characterized by a state close to agitation. The period of depression brings the patient to a complete loss of vitality. He is literally unable to simply get up in bed and carry out any daily activities. There is no strength or desire to maintain family ties, visit the workplace or go to school. Depressive disorder leads to a loss of interest in life itself, which often leads patients to commit suicide or cause physical harm to themselves.

The success of therapy depends on the correct diagnosis and choice of the type of treatment for bipolar disorder for each patient. The decisive factor for success is the acceptance of the presence of the disease by the patient himself and his relatives. Often, it is close people who are the first to contact a medical institution to determine the reasons for frequent mood swings and to exclude the connection between increased emotionality and severe mental pathology, which, as it develops, can destroy the patient’s personal and social life.

Causes of bipolar affective disorder

The onset of the disease is most often diagnosed between the ages of 30 and 50 years. The pathology can equally affect women and men. In some situations, the disorder is detected in elderly patients and children.

As a rule, confirmation of the diagnosis occurs during a personal conversation with a psychologist or psychotherapist. Doctors have not yet identified the exact reasons for the onset. But there are factors characteristic of the majority of patients. Experts distinguish two types of reasons: psycho-emotional and biological.

Bipolar disorder, which has biological causes, is associated with a genetic predisposition. When conducting a family history of the patient, a congenital gene disorder of neurotransmitters is revealed. Such as serotonin, dopamine, norepinephrine. Studies have shown that if there is a predisposition during the period of emotional disorder, there is also a disruption in the interaction of the systems connecting the adrenal glands-thyroid gland-pituitary gland-hypothalamus.

The presence of bipolar disorder in relatives does not become a basis for the entire family to assume the onset of the disease in any of the blood relatives. Doctors have identified a possible cause of a genetic factor as a provocateur of the onset of the disease, but such “unfavorable” heredity is not a death sentence.

The onset of the disease can be caused by taking certain medications prescribed for the treatment of psychiatric diagnoses, antidepressants.

Prolonged or major psycho-emotional trauma becomes a serious provocateur of the start. In this case, increased activity is associated with the need to distance yourself from a depressive situation, and the transition to the stage of depression is associated with the need to give the body rest. It is recommended to consult a specialist in the early stages, which allows you to develop effective treatment options for bipolar disorder.

Epstein–Barr virus

Hepatitis

Herpes

5833 12 November

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Epstein–Barr virus: causes, symptoms, diagnosis and treatment methods.

Definition

The Epstein-Barr virus (EBV) is present in most people, remaining in the body of a person who has been ill for life and being a trigger for various diseases. It is known that in many cases, primary contact with EBV occurs in the first decade of life, causing a persistent (persistent) infection. In early childhood, the disease is usually asymptomatic or with scant symptoms. Primary EBV infection at 10-20 years of age causes respiratory infections in 40% of cases, and infectious mononucleosis is diagnosed in 18-25% of patients.

Epstein-Barr virus can infect various types of cells, including immune system B cells (a type of white blood cell) and mucosal epithelial cells.

EBV is a member of DNA viruses from the Herpesviridae

(herpesviruses), subfamilies of gammaherpesviruses and genus lymphocryptoviruses. During the process of virus replication (self-copying), over 70 different virus-specific proteins are expressed. Currently, groups of immunogenic proteins have been identified, the determination of antibodies to which makes it possible to differentiate the stage of infection (EA - early antigen, EBNA-1 - nuclear antigen, VCA - capsid antigen, LMP - latent membrane protein).

Causes of diseases caused by the Epstein-Barr virus

The virus can spread from person to person through body fluids (airborne transmission). That's why infectious mononucleosis, one of the best-known diseases caused by EBV, is called the "kissing disease."

Another method of infection is through household contact (the virus is transmitted through toothbrushes, cutlery, towels, etc.). EBV can also be spread through blood and semen.

EBV multiplies in B lymphocytes and epithelial cells, and therefore there is a variety of clinical manifestations of this pathology. An important distinguishing feature of the virus is that it does not inhibit or disrupt the reproduction of B lymphocytes, but, on the contrary, stimulates it. This is the peculiarity of the pathogen - it multiplies in the cells of the immune system, forcing them to clone their own viral DNA.

The chronic inflammatory process caused by EBV leads to structural and metabolic disorders of the affected tissues, which is the cause of various somatic pathologies.

Classification of Epstein-Barr virus

There is no unified classification of Epstein-Barr virus infection (EBVI); the following is proposed for use in practical medicine:

• by time of infection - congenital and acquired;
• according to the form of the disease - typical (infectious mononucleosis) and atypical: erased, asymptomatic, with damage to internal organs;
• according to the severity of the course - mild, moderate and severe;
• according to the duration of the course - acute, protracted, chronic;
• by activity phase – active and inactive;
• mixed infection - most often observed in combination with cytomegalovirus.

Symptoms of the Epstein-Barr virus
Below is a partial list of diseases with which the Epstein-Barr virus is associated.

• Infectious mononucleosis (glandular fever, Filatov's disease) is a common infectious disease, the main manifestations of which are a rise in temperature to high values, enlarged lymph nodes, inflammation of the mucous membrane of the pharynx, enlargement of the liver and spleen. EBV in this case penetrates the epithelium of the mucous membranes of the upper respiratory tract.

• Lymphogranulomatosis (Hodgkin's disease) and some types of non-Hodgkin's lymphomas are a group of diseases united by malignant monoclonal proliferation of lymphoid cells in the lymph nodes, bone marrow, spleen, liver and gastrointestinal tract.
• Chronic fatigue syndrome is a condition characterized by a prolonged feeling of fatigue that does not go away after prolonged rest.
• Alice in Wonderland syndrome is a condition whose clinical manifestation is a violation of the sensation of one’s body and its individual parts. A person feels himself or parts of his body to be very large or very small compared to reality.
• Hepatitis caused by EBV is often a complication of infectious mononucleosis. Weakness, nausea, yellowness of the skin and mucous membranes appear, and the liver enlarges.
• Herpetic infection in the form of a genital or labial (on the lips) lesion. Stomatitis caused by EBV is also possible. When the infection is activated, a burning sensation and pain appear, followed by many small blisters.
• Post-transplant lymphoproliferative disease is a secondary malignant disease that develops after hematopoietic stem cell transplantation (a treatment method used for oncology, blood diseases, etc.), associated with EBV infection.
• Multiple sclerosis is a chronic autoimmune disease that affects the myelin sheath of nerve fibers in the brain and spinal cord. It is characterized by a large number of symptoms and depends on the level of damage: muscle strength often decreases, reflexes fade, and paralysis (immobility) of various localizations appears.
• Hairy leukoplakia - white areas with a rough surface appear on the mucous membrane of the tongue on the sides, back or lower part. They are painless and do not cause significant discomfort. The main danger lies in the possibility of malignancy of the altered mucosal cells.
• Nasopharyngeal carcinoma is a malignant tumor of the pharynx. Its symptoms often include nasal congestion, hearing loss, frequent ear infections, the appearance of blood in saliva, bloody discharge from the nose, enlarged lymph nodes, and headaches.
• Autoimmune thyroiditis is a chronic disease of the thyroid gland in which antibodies to the thyroid tissue are formed in the body. With this disease, a goiter (enlarged thyroid gland) may appear, and symptoms of hypothyroidism may develop: swelling, increased fatigue, drowsiness, constipation, dry skin, hair loss.

Diagnosis of Epstein-Barr virus
Diagnosis of EBV, regardless of the form of the disease, should be carried out taking into account the epidemiological history, clinical picture and results of laboratory examination.

Laboratory examination includes:

• Epstein-Barr virus, determination of DNA in blood (Epstein Barr virus, DNA);

Bipolar affective personality disorder symptoms and signs

Regardless of the age and gender of the patient, in most cases the onset of the disease is associated with the manifestation of depression. Such an episode is noted as a trigger in 70% of patients. The remaining 30% of patients call the starting point of the onset of the disease an episode of mania. Moreover, in both starting situations, in a personal conversation with a doctor, patients recall cases of frequent mood swings.

This pathology is characterized by the presence of three phases:

• Manic, the period of which a person suffers from actions and thoughts replacing each other at a fast pace. There is simultaneously a combination of logical and confused thoughts, logical and inexplicable actions. Such leapfrog leads to feelings of anxiety and dissatisfaction, irritability and anger.
• During a depressive period, the patient feels a complete loss of strength, loses faith in himself and his future.
• With hypomania, the presence of manic symptoms is detected, but at a lesser stage than directly during the manic period.

The listed stages replace each other. A feature of the course may be a long period of remission, during which the manifestations of the disease may be invisible even to a specialist who has not previously worked with this patient. Each period can last from several days to several years.

Signs of bipolar disorder in women

Statistics show that women suffer from this disease more often than men. The course of the disease in women is associated with hormonal status. To develop a competent therapy program, specialists develop prescriptions during puberty, the period of bearing a child, and the onset of menopause.

Also among the features of the development of pathology in women are:

• the prevalence of prolonged depressive disorders, occurring more often than in men;
• type II BD with rapid cycling and mixed type develops more often;
• episodes of mania and hypomania are often triggered by taking antidepressants;
• the course of the disease is accompanied by physiological disorders;
• weight gain occurs and the menstrual cycle is affected.

Negative factors include long-term diagnosis, often associated with the assumption of a connection between mood changes and the characteristics of female psychology.

Signs of bipolar disorder in men

Traditionally, men are recognized as less emotional than women. The initial period of the disease is characterized by shallow sleep and a sharp change in emotional status. Unlike women, representatives of the stronger half more often suffer from a manic episode at the onset of the disease. In some cases, there is a decrease in libido and sexual function is impaired.

On average, men develop bipolar disorder one and a half times less often than women. Their disease is more complicated.

Signs of Bipolar Disorder in Teens

Bipolar disorder can be diagnosed not only in adults. Minors may be susceptible to this disorder. The high-risk group for developing bipolar disorder in childhood and adolescence includes those who have already been diagnosed with this disorder in their family. If parents, grandparents, or other close relatives have bipolar disorder, the disease manifests itself in 50% of patients who complain of frequent mood swings.

Among the provoking factors:

• consumption of alcohol and psychotropic drugs;
• difficult emotional situation in the family or at school;
• physical head injuries leading to brain damage.

The first signs of pathology may appear in preschool age, the first months of life. Children may exhibit sexually suggestive behavior and begin to repeat words and phrases they hear. Sexual arousal in bipolar disorder is especially active at the age of puberty.

Severity

At the stage characterized as mild, the person behaves a little eccentrically. At these moments, the patient has no desire to criticize and change his, at times immoral, behavior. Despite this, loved ones have every chance of successfully pushing a person to correct his attitude towards the world.

The average degree of the disease is accompanied by more pronounced personality changes. Patients most often notice these changes, but have no desire to criticize themselves. The symptoms inherent in the patient during the depressive and manic phases are noticeably intensified, and the transition between them is clearly visible.

A severe degree of the disease is characterized by almost complete awareness on the part of the individual about his painful condition. At the same time, a person cannot resist the desire to commit terrible actions, which include violence, suicide and murder.

Types of Bipolar Affective Disorder

In medical practice, there are several types of bipolar disorder:

• Type I with the manifestation of manic symptoms or mixed symptoms;
• Type II, which is characterized by depressive symptoms;
• cyclotomy;
• nonspecific disorder.

Each type has individual specifics, which influence the choice of therapy and prognosis for the development of the disease.

Bipolar manic disorder

At this stage, patients feel increased activity and are agitated. The patient exhibits activity and sociability, which are normally unusual for him. Sexual desire increases, the need for sleep sharply decreases. Patients feel their own greatness, experience ideas of their superiority.

Dysphoric mania may occur. Patients, instead of a feeling of superiority and increased activity, combined with a very good mood, experience constant irritability and dissatisfaction.

Bipolar depressive disorder

Characterized by decreased mood and activity. Patients lose interest in those things that previously seemed attractive and interesting. It is accompanied by disturbances in appetite and sleep, and with the development of pathology, suicidal thoughts arise.

Bipolar affective disorder

It differs in its course, in which frequent mood swings occur with a transition from mania or hypomania to a state of deep depression. With this type, mixed states are often observed, which are often indistinguishable from agitated depression, characteristic of people with neurological disorders and an exalted character. This may prevent timely contact with a specialist.

Diagnosis of manic-depressive psychosis

The diagnosis of the disease was first described by the French physicians Felret and Baillarger in 1854, but TIR received the status of a separate disease only in 1896. The reason for recognition as a separate nosological unit was the work of Kripelin. Then the name manic-depressive psychosis appeared. After the introduction of the international classification ICD-10, the diagnosis was called “bipolar affective disorder”.

The causes of this pathology are not precisely understood, but clinical observations indicate two potential causes of the disorder:

• congenital predisposition;
• a combination of external factors, aggravated by negative heredity.

Diagnosis is carried out in a personal conversation with a psychiatrist. The doctor studies the patient’s medical history and lifestyle. If the assumptions are confirmed, tests are prescribed. The specialist’s conversation is carried out both with the patient himself and those around him.

The onset of pathology in most cases occurs at a young age. The further development forecast is negative. If left untreated, symptoms increase. In the case of therapy and successful removal of the pathological condition, 90% of patients experience repeated attacks, requiring lifelong monitoring by a psychiatrist.

The psychiatrist identifies the presence of various stages of MDP using scales. It is necessary to exclude psychosis, schizophrenia, and psychopathy.

Bipolar disorder phase

In medical practice, there are two phases of this pathology:

• Depressive, characterized by a depressed mood, a feeling of hopelessness, decreased interest in everyday activities; patients develop self-rejection and a desire to commit suicide.
• Manic is accompanied by an increase in motor arousal, increased mood, and idiomatic mental arousal.

A significant proportion of patients are faced with a mixed version of the phases. When conducting an oral conversation with a doctor, manifestations of phases are revealed that are present simultaneously or appear with a short time interval.

Treatment of affective bipolar disorder

The development of a course of treatment for bipolar disorder is carried out by a psychologist or psychotherapist. An individual program is drawn up for each patient, which takes into account:

• patient's age, gender;
• frequency of attacks, duration of remissions;
• present concomitant diseases;
• type and phase.

Like other affective disorders, the prognosis for the development of the disease is initially difficult to predict. The doctor develops a treatment option, checking which medications and psychological practices help the patient.

Bipolar disorder in adolescents

Bipolar disorder in adolescents is difficult to diagnose. Its manifestations may be similar to teenage whims associated with hormonal changes. Some experts suggest the presence of symptoms of bipolar disorder at the initial stage in almost half of young men and adolescent girls. About 1.5% of young people are formally diagnosed.

Therapy is based on correcting the disorder primarily through psychological training and sedative medications. It is recommended to take B vitamins that strengthen the nervous system.

According to indications, it is recommended to prescribe antipsychotics, mood stabilizers, antidepressants, and sedatives. The use of medications in the treatment of adolescents is used in situations of recovery from an acute condition.

Bipolar disorder in women

In the fair sex, the manifestation of bipolar disorder is characterized by starting with a depressive episode. A peculiarity of diagnosing bipolar disorder in the fairer sex is the frequent failure to identify the diagnosis, the manifestation of which is associated with a naturally elevated emotional status. In an attempt to independently overcome mood swings, women often bring the disease to the stage of frequent alternation between a depressive state and manic states.

When developing a course of therapy, the need to adjust the course depending on the hormonal status of the patient is taken into account. Puberty, any termination of pregnancy (abortion, miscarriage or childbirth), menopause can provoke an exacerbation of bipolar disorder and change the symptoms of the disease. An exacerbation can provoke the simple onset of monthly menstrual bleeding.

Treatment uses a combination of atypical psychotics and mood stabilizers. The disease is often accompanied by physical pain and increased body temperature. Antipyretic and analgesic drugs are used in treatment.

Each patient undergoes a course of individual and group psychotherapy. This allows you to relieve a high degree of tension, anxiety, and reduce the level of depression.

Bipolar affective disorder in men

Considering that men more often suffer from the onset of a manic phase, preference in therapy is given to sedatives and sedatives. It is not recommended to stop using medications at the stage of relapse or first manifestation. The use of medications ensures rapid relief of an active condition that is dangerous for the patient. Further, it is recommended to prescribe medications that ensure long-term, ideally lifelong, remission.

A feature of therapy for men is the frequent refusal of patients to accept the presence of a diagnosis. Starting with a manic episode, accompanied by increased activity and performance, allows patients to simply assume that they have a colossal amount of vital energy. Most men positively accept their unexpected increased sexuality, from their point of view, additionally confirming success and strength. The lack of therapy leads to a change from a manic stage to a depressive stage with severe symptoms.

An important condition for the successful treatment of bipolar disorder in men is the joint work of relatives and doctors. This helps to seek medical help in a timely manner.

Bipolar disorder in patients of any gender is currently not completely curable. The condition must be monitored for life by a specialist. In most situations, a preventive examination, prescribed once every few months, is sufficient.

When life factors occur that can provoke a relapse, patients are advised to seek advice on their own. Provocateurs are individual for everyone. This could be a long-term stressful situation, a sad or joyful event. Patients with bipolar disorder and their relatives are advised to remember the need to promptly stop a potential exacerbation.

Treatment of manic-depressive psychosis

The first step of therapy is the elimination of provoking negative external factors. This, first of all, refers to the onset of pathology against the background of prolonged drug or alcohol intoxication, which often becomes the trigger for MDP. It is necessary to eliminate other stressful cases that are traumatic to the patient.

Types of therapy differ depending on the stage. Antidepressants are recommended in case of depression, combined with mood stabilizers and atypical antipsychotics. The dosage is determined individually for each patient. The prescription is carried out only by a doctor, since there is a risk of provoking the transition of a depressive state to a manic state.

The exit from the manic stage is carried out by prescribing mood stabilizers. Antipsychotics are additionally included in severe stages.

With a properly selected course of therapy, patients recover completely, but the unfavorable prognosis is confirmed by the alternation of periods of remission with attacks of the disease. Return of the diagnosis is observed in 90% of patients. In case of a complex course, therapy is possible only in a hospital setting. Mild stages can be treated using outpatient treatment.

About 30% of patients do not go into remission. Most often, this course of diagnosis is observed in patients with alcohol or drug addiction. MDP is often accompanied by other psychiatric diagnoses.

How to live with bipolar disorder

People who have been diagnosed with bipolar disorder need to self-manage their health. Contacting a doctor is required at the first manifestation of symptoms. In this list:

• unexpected mood swings from unbridled joy to deep sadness over the course of several hours;
• loss of interest in life, leading to physical weakness and apathy;
• excessive excitement, in many cases accompanied by loud laughter and unmotivated joy;
• loss of appetite, weight can either begin to increase or decrease, the usual order of eating and taste preferences change.

Patients themselves may pay attention to other unusual factors caused by changes in their psycho-emotional state.

In the case of the presence of attacks in the past, patients with bipolar disorder know what symptoms may accompany the completion of remission. If there is a suspicion of a new attack, the patient is recommended to contact the treating psychologist or therapist.

At the same time, the diagnosis should not be perceived as a sentence that forces you to give up your usual way of life. With properly selected therapy and timely consultation with a doctor, bipolar disorder can go into a state of long-term, even lifelong, remission. Monitoring the patient’s condition by doctors and relatives, including the patient himself, is required for life. The lack of accurate data on the causes of this disease excludes the possibility of developing preventive measures.

Compliance with the rules for monitoring well-being and psycho-emotional state will help patients with bipolar disorder of any type maintain the quality of life of an almost completely healthy person. Attending psychotherapy courses and starting to take medications maintains emotional balance within normal limits in a large number of patients for many years. As a rule, others have no idea that a patient who constantly monitors himself has a complex and life-threatening pathology.