Bipolar disorder

Being a manic-depressive - or bipolar as it is now commonly referred to - was determined a few decades ago, while living in Lelystad. Part of it may have been "passed down" from my own father, who also had a bipolar disorder. 

This Summer it dawned on me that I'm aware when a depression is setting in, but I had never felt any advance warning for a manic episode? Was that just me, or...? At the time I did not look into the question any further, but recently I was looking up something else and found answers on Internet...

No, I was not educated to identify an oncoming manic episode, or what situation, like divorce or losing your home, might trigger an episode. I was never "managed" or educated by an interprofessional team. 

So, sadly, looking back, I became the "poster child" for a bipolar disorder patient, including times when I stopped taking my medication, making bad choices, and now being stuck with no way forward or reverse. 


Source: 
https://www.ncbi.nlm.nih.gov/books/NBK493168/ 

• Deterrence and Patient Education

It is important for patients to be educated regarding the episodic nature of mania as well as how to identify the initial manifestations, heralding an oncoming episode.

• Prognosis

The prognosis of manic patients is favorable, granted they are adherent to medications and therapy. Some factors associated with a poorer outcome are a history of abuse, psychosis, low socioeconomic status, comorbid illness, or young age of onset.

• Complications

The sequelae from a manic episode can be detrimental. Those suffering from mania often act with impropriety, ruining reputations and careers. More consequential complications include physical harm to others and self.

• Pearls and Other Issues

One of the major illnesses which may mimic bipolar disorder and have manic-like symptoms is cyclothymic disorder. Cyclothymic patients may have large mood swings which do not meet the full criteria for a manic or hypomanic episode. These patients may also have many periods of depression. The criteria for cyclothymic disorder involve having many hypomanic or depressed symptoms on and off for at least 2 years that do not remit for more than 2 consecutive months. The symptoms in cyclothymia must cause significant social or occupational impairment and cannot be better explained by substance abuse.

• Enhancing Healthcare Team Outcomes

Manic patients are very difficult to manage and hence an interprofessional team consisting of a mental health nurse, psychologist, psychiatrist, and primary care provider is required. Once the acute episode is managed, patients will need a prophylactic agent to prevent a recurrence. Unfortunately, patient compliance with medications is low and relapses are common.

The outcomes for patients with mania are guarded. Those who do no comply with treatment eventually run into problems with the law and/or are forced to take medications via injection.