Bipolar disorder is a mental illness in which two psychopathological states are experienced alternately – apathy and euphoria (we then speak of a depressive phase and a manic phase).
One of the neurotransmitters – dopamine – is responsible for the occurrence of euphoria. This substance is associated with people’s feelings of happiness and joy. These feelings appear when dopamine is increased in the structures of the central nervous system. The fact that dopamine works in a “euphorizing” way is proven by the fact that people who have its deficiencies may not be able to feel happiness and joy.
Mood changes range from extreme sadness to extreme joy. In the euphoric phase, patients suddenly become reckless and unceremonious. They then make risky and thoughtless decisions, and their rationalization ability decreases. They may also need contact with people. It also happens that outbursts of aggression accompany euphoria in bipolar disorder.
2.
Talkativeness is speaking a lot. It may be incessant speaking without order and structure, i.e., without giving the statement an understandable form and essential content. Sometimes, it is incomprehensible to babble to oneself or someone else.
A person speaks incessantly, not caring whether someone is listening to them or whether they understand them. If it turns into otorrhoea, it requires seeing a doctor as soon as possible. That is because it usually indicates a serious illness or brain damage.
Talkativeness appears in bipolar disorder and in manic episodes. In this state, the patient experiences racing thoughts, their statements take the form of “word salad”. Moreover, their talkativeness is difficult or even impossible to control.
3.
Impulsivity is a complex phenomenon that eludes a single universal definition and has both behavioral and cognitive manifestations. Most current definitions of impulsivity describe it as a tendency to engage in ill-considered behavior that is difficult to postpone. The action is taken so quickly that it is impossible to assess its consequences.
Impulsive behavior can occur as a dominant symptom in many mental illnesses and disorders, especially in bipolar disorder. Another large group of illnesses in which impulsivity plays a significant role are disorders associated with loss of impulse control. However, it is worth emphasizing that impulsivity can also occur in people without mental disorders as a personality trait. It can also be a temporary, transient state, occurring secondary to factors such as severe stress.
People characterized by high impulsivity are often at increased risk of developing. For example, addiction to psychoactive substances or bipolar disorder in the future. It is worth noting that the use of psychoactive substances, through their effect on the central nervous system (CNS), especially the frontal lobes, can cause impulsive disorders, which often manifest themselves as disinhibition and increased impulsivity. The biological basis of impulsivity is still not fully understood. However, the role of the balance of the serotonin and noradrenergic systems is emphasized as key.
4.
In the course of bipolar disorder, various types of sleep disorders often occur (difficulty falling asleep, and maintaining sleep continuity); it may also be accompanied by insomnia or excessive sleepiness during the day. The patient may wake up multiple times during the night or, which is characteristic of depression, in the early morning hours. Then, they may fall asleep again or – when the disease intensifies – have difficulty doing so.
These sleep disorders also gradually disappear with the disappearance of depression symptoms during treatment or with the introduction of appropriately selected antidepressant treatment that takes into account sleep disorders.
In the case of insomnia in bipolar disorder, the role of the family may consist of helping to maintain sleep hygiene, for example, by ensuring that the patient goes to bed at the same time and avoids (as much as the severity of depression allows) laying around in bed and dozing off or napping during the day, avoids activities in bed that are not related to sleep, avoids drinking coffee or energy drinks in the evening, stays in bright light in the morning and the first half of the day, and dimmer light before going to bed, have comfortable conditions in the bedroom (quiet, moderate temperature, clean bedding).
5.
Depression in bipolar disorder can also manifest itself in cognitive conditions, e.g., concentration, attention, and memory. These symptoms can cause anxiety in both the patient and their loved ones, who sometimes try to “force” patients to read newspapers or watch films.
In the case of depression, there is no such need because these symptoms usually disappear completely with the improvement of the mental state.
It is worth making the patient aware of this, especially in the case of deeper depression, when they may have a constantly resurfacing fear that they have irretrievably lost their intellect, that they have “gone numb” and will not be able to return to their previous mental condition, return to work and previous activities.
6.
In developed mania in bipolar disorder, individuals may experience what are known as grandiose delusions. During this state, patients may feel an exaggerated sense of their strength and importance, believing they are someone of significant social or political relevance, which is not aligned with reality. They might develop a sense of mission, such as “fixing or healing the world and the people around them”.
This inflated self-perception often leads to an immediate desire to satisfy their needs without delay. As a result, if family members try to explain, prohibit, or deny the patient permission to pursue these activities, it can trigger irritability, anger, and even aggression—either verbal or physical.
At times, individuals in mania may exhibit an irritable and angry mood that arises seemingly without cause, accompanied by verbal or physical aggression towards others or objects in their environment, as well as self-directed aggression, which includes self-harm. Moreover, during mania in bipolar disorder, if it escalates into a mixed episode, patients may also experience suicidal thoughts and tendencies, particularly dangerous when they are in an irritable or angry state.
7.
The patient with bipolar disorder may abuse alcohol and psychoactive substances, even if they did not do so before the disease. Many other impulsive activities also appear, the purpose of which is broadly understood as pleasure.
They may also undertake various commitments, take out loans and credits, spend money excessively unusually, and gamble “with collateral.” A patient in mania in bipolar disorder very often has an excessive sense of self-worth and an inadequately or excessively inflated self-esteem; they assess the present and the near future too optimistically.
An interesting phenomenon reported by some patients is a sense of sharpening the senses, giving the impression of a much more intense experience of tastes, colors, and sounds. It may manifest in a change in the patient’s external appearance (e.g., the appearance – contrary to previous habits – of bright and excessive make-up, dressing in bright and contrasting colors) and a tendency to listen to loud music or behave loudly and risk-taking.
8.
Gradual loss of joy in life and pleasure in bipolar disorder is the inability to appreciate things and events that were formerly experienced as joyful (anhedonia).
Lowered mood and experience, combined with indifference, a sense of emptiness. Periodically changeable (labile), grumpy mood, difficulty in controlling mood and sadness (deep and severe, experienced most of the time), crying that is increasingly difficult to handle, and sometimes incapacity to manage emotions, impulsiveness incompatible with prior behavior.
Anhedonia is considered an important risk factor for attempting suicide. Therefore, if a person who has a depressive episode in bipolar disorder experiences states, e.g., panic attacks, anxiety, lack of concentration, insomnia, and advanced anhedonia, there is an increased risk of attempting suicide. People close to the patient must be aware of this and can take preventive measures in time, and above all, make sure that the patient does not discontinue treatment.
9.
Depressive thinking in bipolar disorder is a pessimistic assessment of one’s past, present, and future, low self-esteem, and a sense of being worthless. Sometimes, depressive delusions (inaccurate judgments that the individual considers to be accurate, despite fruitless attempts to confront them with reality). Those concern a sense of guilt, being a sinner, punished, convicted, or concerning poverty, destitution, lack of any prospects for future for oneself and family. The existence of such delusional beliefs is an unquestionable expression for consultation with a specialist.
If a patient with severe depression has severe depressive delusions, then they are convinced of “their reasons”; they are sure of them, and their loved ones, despite attempts, fail to correct this belief, explain to them that it is different, comfort them.
Sometimes, these attempts make the patient feel ununderstood by anyone, lonely in their world of beliefs, alone carrying their burden, or they become suspicious of their loved ones. They are convinced they are trying to hide the truth from them to comfort them in a hopeless situation.
10.
Limitation of life activity, gradual loss of previous interests, problems in undertaking different activities and actions, up to the radical abandonment of these actions, appear in bipolar disorder.
It also comes with gradual loss of life energy and reduced sensitivity to emotional stimuli (apathy) and increased fatigability, chronic fatigue with limitation of daily activity.
Sometimes, psychomotor agitation associated with a feeling of increased internal tension, anxiety, and incapability to find one’s place.
11.
Anxiety is not a common symptom of depression in bipolar disorder, but it frequently occurs alongside it. Patients often experience a persistent feeling of anxiety without being able to pinpoint the source of their fear, which is known as unspecified anxiety.
This type of anxiety in bipolar disorder tends to be chronic, with its intensity fluctuating over time (referred to as free-floating anxiety). Many patients report that they feel this anxiety manifesting somewhere in their bodies, such as in the chest.
Internal anxiety can be felt generally – without a specific location of this ailment – and the patient may experience this problem in a specific place of the body. The most common complaints are a feeling of internal anxiety in the chest or a feeling of internal anxiety in the abdomen. This problem can be both transient and quickly passing, and patients can experience chronic internal anxiety.
12.
A growing sense of loss of meaning in life may vary from a wish to die naturally to thoughts of committing suicide. Suicidal thoughts often appear against the will of the individual, who attempts to manage and ignore them, but with time, it becomes increasingly challenging.
Often then, the patient cries for help, among others, informing the people around them about it. In extreme circumstances, the individual starts to think about how they will commit suicide.
It can be carefully planned, but it can also be unplanned and sudden. Thoughts of resignation, death, and suicide are also fundamental signs for psychiatric consultation.
13.
A decreased or lost appetite is quite common among patients with bipolar disorder. Many report that they force themselves to eat because they know they need to or because the food lacks taste. It can sometimes lead to effective weight loss.
Conversely, depression can also manifest as an increased appetite and unusual overeating, particularly of sweet foods. This behavior, alongside a lack of physical activity and taking medicine, can result in weight gain.
It is worth remembering that how we eat every day affects our well-being. For this reason, it is worth looking at our diet and making any changes if we notice a drop in mood. What is more, it is always worth consulting a specialist.
14.
A decreased sexual drive (libido) in women and men often occurs in depression in bipolar disorder. Decreased or lost interest in the sexual sphere can intensify the depressive feeling of reduced self-esteem and attractiveness. And this, in turn, can affect an even grander weakening of libido.
Moreover, those individuals often exhibit elements of body dysmorphia (disorders in the perception of one’s appearance). This is, of course, reflected in low self-esteem and reduced desire for sex.
Sexual life is not enjoyable and does not provide satisfaction. It can also intensify the experience of depression. Sexual disorders accompanying depression most often disappear with the improvement of mood when treated with appropriate medications.
15.A so-called circadian fluctuation of well-being is characteristic of typical forms of depression. Individuals usually feel worse in the morning and afternoon and find it challenging to begin the day. In the evening, they feel slightly better and more active.
In the progressive therapy of depression, the evening hours of better well-being “extend” towards the afternoon hours first and then the morning hours.
However, there are also individuals with depression who feel better in the morning than in the evening hours or do not have a feeling of circadian fluctuations in their mood.
