BIPOLAR DISORDER

BIPOLAR DISORDER

Bipolar disorder by definition is a mental illness characterised by episodes of an elevated mood known as mania, usually alternating with episodes of depression.

During mania an individual feels abnormally happy, energetic, or irritable , but often makes poor decisions due to unrealistic ideas or poor regard of consequences.

Maniac and depressive episodes can impair the individuals ability to function in ordinary life.

SIGNS & SYMPTOMS.

1.Mania

2.Hypomania

3.Psychosis

Maniac episodes.

-distinct period of atleast one week of elevated or irritable mood which can take the form of euphoria & exhibit three or more of following behaviours :

-speak in a rapid uninterrupted manner

-easily distracted

-having racing thoughts

-display an increase in goal oriented activities or feel agitated

-exhibit behaviours characterised as impulsive

-excessive money spending

-to meet criteria for mania episodes these behaviour must impair the individuals ability to socialize or work.

IF UNTREATED A MANIAC EPISODE LAST 3-6 MONTHS

Hypomaniac episodes

-milder form of mania defined as four days of the same criteria for mania with lesser symptoms

-does not cause a significant decrease in individuals ability to socialise or work ,lacks psychotic features and does not require psychiatric hospitalisation

-overall functioning may increase during episodes of hypomania and is thought as a defence mechanism against depression

-hypomaniac episodes rerely progress to true maniac episodes

-patient may feel good even when family and friends recognise mood swings

Depressive episodes

-persistent feeling of sadness

-anxiety

-guilt

-anger

-isolation

-hopelessness

-disturbances in sleep and appetite

-fatigue and loss of interest in usually enjoyable activities

-problems concentrating

-self loathing

-apathy or indifference

-depersonalisation

-loss of libido

-shyness or social anxiety

-irritability

-chronic idiopathic pain

-lack of motivation

-morbid suicidal thoughts

-severe cases psychotic delusion & hallucination

Mixed affective episodes

-high risk for suicidal behaviour

-hopelessness often paired with mood swings or diificulties with impulse control

-anxietty disorder occur more frequently as a co morbid condition

Associated features

-changes in cognitive processess & abilities

-reduced attentional capabilities

-impaired memory

-diificulty in maintaining relationships

Comorbid conditions

OCD/SUBSTANCE ABUSE/EATING DISORDERS/ADHD/SOCIAL PHOBIA/PMS/PANIC DISORDERS

CAUSES

Genetic

-60 to 80 % account for genetic influences

-risk of bipolar disorder is ten fold higher in 1st degree relatives of those affected with bipolar disorder when compared to general population

Physiological

-increase in volume of lateral ventricles, globus pallidus, and increase in rates of deep white matter hyperintensities

-abnormal modulation between ventral prefrontal and limbic regions especially the amygdala

-early life stress dysfunction of hypothalamic pitutary adrenal axis leading to its over activation

-alterations to mitochondria and sodium ATP ase pump are believed to cause cyclical periods of poor neuron firing(depression) and hypersensitivity neuron firing(mania)

Environmental

-traumatic abusive episodes in childhood

-stressful events in childhood

Neurological

-stroke

-traumatic brain injury

-multiple sclerosis

-porphyria

-temporal lobe epilepsy

Neuroendocrinal

-dopamine

-gamma amino butyric acid

-glutamate, these are neuro transmitters known for mood cycling.

Evolutionary origin of bipolar disorder states that during short summers of extreme climatic zones , hypomania would be adaptive, allowing completion of many tasks necessary for survival within a short period of time. During long winters the lethargy , hypersomnia, lack of interest in social activities, and over eating of depression would be adaptive to group cohesion & survival.

Diagnosis

M-severe mania

D-severe depression

m-less severe mania

d-less severe depression

BP 1 Disorder                   : Md

BP 11 Disorder                 : mD

Cyclothymia                      : md

Non Specific BP Disorder  :  any symptomsM/D/m/d

Differential Diagnosis

-schizophrenia

-major depressive disorder

-attention deficit hyperactivity disorder

-borderline personality disorder

Medications

-cognitive behavioural therapy

-family focussed therapy

-psycho education

-interpersonal & social rythm therapy

-anticonvulsants,antipsychotics

AYURVEDIC APPROACH TOWARDS BIPOLAR DEPRESSIVE PSYCHOSIS

Ayurveda offers a multitude of holistic tools and ways of approaching this disease that can restore health so as to not rely as heavily on conventional treatments.

Ayurveda uses a general term UNMADA for insanity. According to Charaka unmada is wandering about of mind, intellect, consciousness, knowledge, memory,, inclination, manners, activities and conduct.

According to Ayurveda bipolar disorder manifests due to imbalance in three fundemental biological qualities that govern body and mind ; vata, pitta and kapha and the mental principles of sattwa, raja, tamas, which are the qualities of consciousness.

Some modern ayurvedic practitioners like BPD to lack of stability of ojas. OJAS is defined to maintain immunity, strength, integrity and vitality. It acts as containers that holds the other two energies in the body ; tejas-the energy of intelligence and discrimination; and prana the body’s life energy. During elated phase , praana and tejas are high, during depressive phase will be low and tejas can be either high or low.

The maniac , depressive and hypomaniac symptoms can be caused due to vata, pitta, kapha or two combinations of these and all the three combinations of the dosas.

When vata causes elation symptoms such as talkativeness, excessiveness, racing thoughts, hyper sexuality, euphoria, impulsive over spending are seen.

When vata causes depressive symptoms emptiness, hopelessness, difficulty concentrating, insomnia, restlessness, memory problems, uncontrollable crying, weight loss, despair are seen.

When pitta causes elated symptoms over-confidence, irritability, aggression. anger, under-sleeping, hyper activity are seen.

When kapha causes depressive symptoms feelings of sadness, lethargy, lack of enthusiasm, apathy, lack of appetite are seen.

AYURVEDIC TREATMENTS

-regular solid routines and stability, regular waking and sleeping, regular meditation and exercise in morning

-identify and minimise the stressors that trigger changes, reduce workload, keep home tidy, clutter free and clean, give time for everything, it is best healer

-avoid stimulants like coffee and beverages

-nervine tonics become the most important for building stability and mental ojas

-common herbs used are jyotismathi, gingko, jatamansi, oat straw, valerian root, st,john’s wort, gotu kola, aswagandha, brahmi, shatavari, ginseng, shanka pushpi, nutmeg, skull cap, kapikachchu, haritaki, bhrungaraj

-clours like yellow, green, gold, blue, white, violet and purple are considered sattvic colours

-sandalwood, jatamansi, rosemary, cinnamon, thyme, mint, eucalyptus, rose, basil, lavender

-exercise but no over exertion, yoga, qi, gory, pilates and tai chi, aikido, gardening, walking, gentle hiking

-PANCHA KARMA :

 1.therapeutic purgation VIRECHANA in maniac phase

2.therapeutic enema BASTI for vata alleiviation

3.therapeutic emesis VAMANA in depressive phase

4.oleation or SNEHA PRAYOGA for palliation

5.SIRODHARA & SIROBASTI for direct action over brain, mind and subtle energy fields.

Ayurveda is not a quick process and relies on development of healthy routines and habits over a life time, it is important for a patient already diagnosed as bipolar to continue with treatment laid out by his or her physician.

AYURVEDA THE COMPLETE REMEDY, THE COMPLETE CURE !!!

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