Manifestations of various emotions and changes in a person’s mood are typical and depend on many factors – from temperament and character to ongoing events. However, when these changes are excessive, often occurring unexpectedly and for no apparent reason, and emotions get out of control, bipolar disorder may be diagnosed. According to McIntyre et al. (2020), bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania) and lows (depression). Thus, bipolar depression is characterized by a depressed mood, decreased ability to think and concentrate, fatigue, and energy loss. Conversely, bipolar mania is characterized by abnormally optimistic behavior, increased activity and energy, reduced need for sleep, unusual talkativeness, and restlessness. One of the screening tools related to bipolar disorder is the Bipolar Spectrum Diagnostic Scale. McIntyre et al. (2020) assert that its specificity was high, which makes it of undoubted value in diagnosing a wide range of bipolar disorders. Therefore, BSDS has demonstrated high sensitivity in the recognition of the bipolar disorder.
According to Grunze et al. (2018), in severe episodes of mania, it is advisable to prescribe oral forms of dopamine antagonists, among which haloperidol, olanzapine, risperidone, and quetiapine are especially effective. Furthermore, Malhi et al. (2021) affirm that valproic acid is an alternative drug with a lower risk of side effects (dyskinesia). Still, it should not be used in women of reproductive age since the risk of teratogenic effects and damage to the fetus’s central nervous system is very high. It is also possible to use aripiprazole, carbamazepine, and lithium preparations. A short course of GABA modulators may be used to improve sleep quality in agitated, hyperactive patients. Stahl et al. (2017) note that no psychotherapy is an effective alternative for an acute manic episode. If initial therapy has been effective, maintenance treatment should be considered. It is recommended to continue therapy with an effective mood stabilizer or a combination of drugs for 3-4 months, gradually reducing or canceling sedative antipsychotic treatment with first-generation antipsychotic drugs and benzodiazepines.
References
Grunze, H., Vieta, E., Goodwin, G.M., Bowden, C., Licht, R.W., Azorin, J.-M., Yatham, L., Mosolov, S., Möller, H.-J., & Kasper, S. (2018). The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: Acute and long-term treatment of mixed states in bipolar disorder. The World Journal of Biological Psychiatry, 19(1), 2–58. Web.
Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., Singh, A. B., & Murray, G. (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian & New Zealand Journal of Psychiatry, 55(1), 7–117. Web.
McIntyre, R.S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Vedel Kessing, L., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A.H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856. Web.
Stahl, S.M., Morrissette, D.A., Faedda, G., Fava, M., Goldberg, J.F., Keck, P.E., Lee, Y., Malhi, G., Marangoni, C., & McElroy, S.L. (2017). Guidelines for the recognition and management of mixed depression. CNS Spectrums, 22(2), 203-219. Web.