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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