Bipolar: a severe mental illness

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Extract from the article: Long known as manic-depressive psychosis, bipolar disorder is a severe mental illness affecting a growing number of people worldwide. Yet, on average, 10 years elapse between the first signs of the illness and the initiation of appropriate ...

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Long known as manic-depressive psychosis, bipolar disorder is a severe mental illness affecting a growing number of people worldwide. Yet, on average, 10 years elapse between the first signs of the illness and the initiation of appropriate treatment. During this time, suffering can be immense, with a high risk of suicide ; 1 in 2 bipolar sufferers will make at least one attempt in their lifetime, and around 15% will die by suicide.

Bipolar disorder is characterized by alternating phases of exaltation (manic episodes) and deep depression. These episodes can last several weeks or even months, and their intensity varies from one individual to another.

There are many factors involved, including genetic factors, excessive alcohol or drug consumption, or certain intense stresses that are unmanaged or poorly managed.

Signs of a manic episode

During the manic phase, the person seems to be “on fire”. Euphoria overflows, and behavior becomes excessive. The main symptoms are excitement, considerable motor agitation, a rapid, uninterrupted flow of speech, and volubility (i.e., the person speaks quickly, fluently and without pause).

Other symptoms include an excessively euphoric mood, i.e. everything seems easy, the person is in a state of overflowing positive energy, impulsive and risky behavior, e.g. reckless purchases, rash decision-making, high libido, disorganized thinking, flight of ideas. Constant hyperactivity, almost absent sleep with no apparent fatigue, excessive self-confidence, even megalomania, and talking to strangers, inappropriate behavior.

A person in a manic phase may, for example, decide in the middle of the night to climb a mountain or launch an unrealistic project, with no awareness of danger or limits.

Symptoms of a depressive episode

In contrast to elation, the depressive phase plunges the individual into great suffering. The signs are sometimes mistaken for classic depression, but they are part of a cyclical alternation.

Intense fatigue and feelings of incapacity, insomnia or unrefreshing sleep, digestive problems and loss of appetite, loss of libido, difficulty concentrating and making decisions, feelings of worthlessness and excessive guilt are all signs.

A gloomy view of the world, pessimism, recurrent suicidal ideation, with a real risk of acting on it.

The person may remain bedridden, unable to perform even the simplest daily tasks. They feel useless and devalued, expressing low or even very low self-esteem, incapable and sometimes even guilty of existing.

In some people, episodes may be unipolar, i.e. more marked by mania or depression; or mixed, i.e. alternating between the two phases mentioned above.

Altered connection with reality

Bipolar disorder is also characterized by an altered connection with reality during both phases, especially in the exalted mood phase. At the same time, the person may also present psychotic symptoms. The sufferer is unaware that he or she is ill. They may be in total denial of their disorder. In some people, bipolar disorder can become complicated by pure psychosis.

Between episodes, however, the person can return to normal functioning. They can work, interact with others and appear to be doing well. This makes diagnosis even more difficult.

Management

Treatment is based on a combination of medication and psychotherapy.

Without treatment, the phases can last up to 6 months. With appropriate treatment, improvement can be observed within a few weeks. In certain serious cases, compulsory hospitalization may be necessary, in particular to prevent suicide or protect the person from dangerous behavior.

Bipolar disorder is a complex and serious mental illness, requiring early and appropriate treatment. Spotting the signs, understanding how the manic and depressive phases work, and providing non-judgmental support are essential steps towards lasting well-being. If you, or a close relative, present symptoms suggestive of bipolar disorder, don't hesitate to consult a healthcare professional. Early diagnosis can make all the difference.

Raymond DZAKPATA

Article validated by Dr Zinsou Selom Degboe, Clinical Psychologist and Psychotherapist at the Clinique de Psychiatrie et de Psychologie Médicale (CPPM), CHU Campus de Lomé.