World Bipolar Day (WBD), an initiative of the Asian Bipolar Disorder Network (ANBD), the International Bipolar Foundation (IBPF), and the International Bipolar Disorders Association (ISBD), is commemorated on 30 March every year on the birthday of Dutch painter Vincent Van Gogh. . It is aimed to draw attention to the illness and raise awareness on the birthday of the painter, who is also known to have bipolar disorder. The 2021 theme of World Bipolar Day was determined as Covid-19 and isolation.
Psychiatrist Assoc. Dr. Nermin Gündüz made evaluations about bipolar disorder and its treatment in a statement made on the occasion of March 30, World Bipolar Day.
Stating that bipolar disorder is a bipolar mood disorder, Assoc. Dr. Nermin Gündüz said, “We are talking about two different extremes related to mood in illness. One is depressive episodes, that is, attacks with depression. The other is the enthusiasm that we call mania, another phase with exuberance. In order to be able to call it bipolar disorder, a single manic episode, that is, a single euphoric episode, that a person has had throughout his life is enough to diagnose, ”he said.
Insomnia is one of the most important symptoms of manic episode
Providing information about the manic episode of bipolar disorder, Assoc. Dr. Nermin Gündüz said the following:
“Sleep is very important to us. In bipolar patients, the need for sleep decreases during the manic period. So people say: ‘I don’t feel the need to sleep. I go to bed, I can not sleep for sure. But when I wake up in the morning, I definitely get very energetic, I cannot sit still. I can sustain the day. ‘ In this respect, insomnia is one of the most important symptoms of mania. Having insomnia gives us an idea about the attack of the disease. Another is that he feels much more enthusiastic, happier, much more energetic than normal. This situation should continue for at least a week. In other words, the person will have insomnia for a week. During this week, the person will feel very energetic, unable to stay still, active, and feel more enthusiastic or happier than they are. “
You can see outbursts of anger and an increase in speech.
Noting that another emotion that occurs during the manic period may be tantrums, Assoc. Dr. Nermin Gündüz said, “There may be patients who are more angry than normal and who experience bursts of anger. Again, one of the symptoms we are accustomed to seeing in mania is the symptoms and findings related to the speech expressed and observed by the relatives of the patients. How does a manic patient talk? He’s very pressurized, talks a lot. It is not possible to interrupt the patient, to intervene or to intervene too much because he talks too much pressure. In fact, from time to time, patients have objections to this. “They cannot tolerate the interruption of their speech very much.”
There may be an increase in spending
Noting that another symptom of the mania period of bipolar disease is the behavior of spending too much money, Assoc. Dr. Nermin Gündüz said, “The symptom we are used to seeing in these people from time to time is the increase in money expenditures and shopping. Since these people spend a lot of money in their daily life, they can sometimes buy things they don’t need at all. It is possible for them to attract a large amount of credit and have a large amount of debt during periods of attack, ”he said.
Noting that one of the symptoms of the mania period is an increase in sexual desire and sexual interest, Assoc. Dr. Nermin Gündüz said, “Some patients talk about an intense increase. This is again one of the important features of the manic table, ”he said.
Sadness, unhappiness and insomnia are seen in the depressive end
Providing information about the depressive episode of bipolar disease, Assoc. Dr. Nermin Gündüz said, “The depressive episode can go away with an attack of depression. At the depression end, the euphoria phase in mania is the opposite of the energetic universe. In other words, the person feels very unhappy and sad. Unlike insomnia in mania, a person wants to fall asleep, wants to sleep, cannot fall asleep alone. “They often wake up or wake up earlier than planned,” he said.
It is a seasonal disease
Noting that one of the feared situations in the depression phase is suicidal thoughts, Assoc. Dr. Nermin Gündüz stated that bipolar disorder is a seasonal disease and said, “From time to time, these attacks are seasonal. “Especially in the spring months, when entering from autumn to winter, during the stages from spring to summer, patients complain of depressive symptoms from manic or depressive episodes,” he said.
Noting that there are various reasons for the emergence of bipolar disorder, Assoc. Dr. Nermin Gündüz said, “We cannot give a definite answer as to why this disease occurs. But with our current knowledge, we have a clear idea that this disease has a genetic background. In other words, if the person’s first-degree relatives, parents or siblings are diagnosed with bipolar disorder, unfortunately, the risk is slightly higher than other people.
Bipolar disorder can occur in the 20s
Noting that bipolar disorder is one of the diseases with first attacks at an early age, Assoc. Dr. Nermin Gündüz said, “This discomfort begins in periods such as the 20s and the mid 20s, which we are used to seeing frequently. Environmental stresses and sometimes the first attacks occur in male patients during military service because difficulty during military service, separation from the family, and change in sleep patterns can be a source of serious stress. In situations such as military service or in serious, unplanned, sudden stressful situations in a person’s life, unfortunately, an intolerable attack can occur ”.
Bipolar disorder is a disease that can be treated
Emphasizing that bipolar disorder is not a disease to be afraid of, Assoc. Dr. Nermin Gündüz said, “It is one of the diseases that can last for a lifetime and can acquire a chronic quality, that is, a chronic quality. Why isn’t it one of the illnesses we should be afraid of? Because there is a cure. In its treatment, it is aimed to keep these diseases, which we call two separate extremes, in otimia, in other words, to keep them in a range that will not affect the daily life of the person, and will not have serious fluctuations during the day, such as mania or depression. The drugs we use most frequently are lithium. “Lithium is one of the drugs we use to maintain a good mood, especially regardless of mania or depression.”
Inpatient treatment can be recommended
Stating that they sometimes recommend hospitalization treatment in order to prevent the patient from harming himself or his environment during the attack period of bipolar disorder, Assoc. Dr. Nermin Gündüz said, “During this hospitalization, it is aimed to suppress these emotional states of the patients and to suppress the manic phase. “We think that inpatient treatment of patients is appropriate because the patient has the risk of going out of control during attacks such as tantrums, an intense irritability, and an increase in money expenditure.”
Drug treatment should not be stopped without the doctor’s knowledge
Noting that patients’ medication use may differ from patient to patient, Assoc. Dr. Nermin Gündüz said, “The number of attacks the patient has, the number of hospitalizations, whether there is a genetic background are the most important determinants of the duration of drug use. From time to time, patients may discontinue their medication when they are feeling well without cooperating with the doctors who are treating them. Unfortunately, medication interruptions are the main reason for mania or depression to attack. Therefore, drug treatment should be continued in cooperation with a psychiatrist, and the drug should be used until the doctor states that there is no need for medication anymore.
Watch out for sleep disorders!
Noting that sleep disorders are an important predictor of attacks in terms of bipolar disorder, Assoc. Dr. Nermin Gündüz said, “While some sleep disorders such as a decrease in the amount of sleep or insomnia may be specific signs of the onset of an attack, sleep disorders can play a determining role in the clinical findings and the course of the disease in the long term. “It is known that maintaining a constant sleep-wake cycle is the key to preventing the recurrence of mood attacks, and the role of the person’s biological rhythm is very important,” he said.
Noting that environmental factors and stressful life events can also worsen the clinical course of bipolar disorder and trigger attacks, Assoc. Dr. Nermin Gündüz said, “The Covid-19 epidemic has turned into a pandemic in a short time thanks to the very easy transmission of the virus. It has effectively caused material and moral losses worldwide. People had to stay in their homes for a long time within the scope of “social isolation” measures in order to reduce the risk of contamination. “High rates of anxiety disorders, depression symptoms and sleep quality disorders have been detected even in healthy individuals of the pandemic,” he said.
“The normal circadian sleep rhythm of a healthy person depends on the stable relationship between the person’s internal body rhythm and the external environment,” Assoc. Dr. Nermin Gündüz said, “It is known that this stable relationship is basically achieved through exposure to the normal light-dark program. The most important regulator of human biological rhythm is light and social and physical activities. Circadian rhythm and thus sleep quality of individuals who spend most of their time indoors and stay away from social and physical activities are negatively affected. Within the scope of social isolation measures, the sleep quality of individuals who stay at home for a long time may deteriorate. “This is especially important for mental illnesses such as bipolar disorder, where maintaining sleep patterns is one of the basic conditions for maintaining mood stability.”
Pandemic triggered episodes of depression
Assoc. Dr. Nermin Gündüz completed his words as follows:
“Therefore, social isolation has disrupted the sleep-wake cycle and triggered both depression and manic episodes, as our patients were less exposed to biological rhythm regulators such as light. In addition, staying away from social activities enabled them to become introverted, lonely and not get the necessary social support, which triggered the depression attack of our bipolar patients. It seems that the pandemic continues to negatively affect both our physical and mental health. Our bipolar patients were seriously affected by this process. “