25-year-old Dennis* had just completed his undergraduate degree and started a new job at a large firm. His family noticed that he was slightly more irritable than usual, but put it down to the stress of a new job and did not think much of it.
In fact, Dennis had been catching only about an hour of sleep — if any at all — and was skipping most of his meals, which resulted in him losing a significant amount of weight. Initially, Dennis’ employers had praised his productivity, but they soon grew frustrated with his lack of focus on projects assigned to him. Things came to a head when Dennis was arrested for attempting to steal jewellery; he was found to be in an extremely elated state, proclaiming that these items were his “birthright”.
Dennis was brought to an emergency department for assessment by a doctor. The doctor found him to be highly energetic, irritable, impulsive, overly familiar and speaking very fast. After conferring with his family, the doctor also ascertained that a few years previously, Dennis had an episode of severe low mood that lasted for weeks. He was tired and lethargic all the time, could not get out of bed, barely ate or slept, found no enjoyment in his usual hobbies, and frequently talked about wanting to end his life. That was attributed to relationship problems at that time, and Dennis eventually recovered slowly over a few months. With evidence pointing to a relapse after the recovery, Dennis was diagnosed with bipolar disorder. *Based on a generalisation of a patient’s account.
Experiencing highs and lows
Dennis is an illustration of an archetypal bipolar disorder patient, who experiences distinct episodes of extreme high moods, known as manic episodes, and extreme low moods, known as depressive episodes, each lasting days to weeks.
There is presently no clear cause of bipolar disorder, but a family history of bipolar disorder increases an individual’s risk of developing the illness. Social factors such as marital discord and unemployment could also be both contributory factors and outcomes of such mood problems.
Identifying and managing the issue
At Changi General Hospital (CGH), the Department of Psychological Medicine diagnoses patients through clinical interviews, with thorough histories obtained from both patients and their caregivers, to identify the clinical features of the illness. Psychiatrists might also use objective rating scales such as the Bipolar Depression Rating Scale (for symptoms of low mood) or the Young Mania Rating Scale (for symptoms of high mood) to identify symptoms and assess their severity. It is advisable for those with symptoms to seek medical attention promptly, as early identification and treatment of the condition greatly improves treatment outcomes.
Medications for treatment include mood stabilisers which target both extreme elated and depressed moods. Some also benefit from concurrent anti-depressants or sedatives. Patients may benefit from interpersonal and social rhythm therapy, where a therapist works with the patient in identifying disruptions in rhythm — such as changes in sleep patterns that can provoke relapses in bipolar disorder — and teaches them how to maintain routines to minimise these kinds of disruptions. Medical social workers may also be involved in the care of patients to manage contributing social factors, such as familial or marital discord, and difficulties in maintaining schooling or employment.
Caring for persons with bipolar disorder
Caring for a loved one with bipolar disorder can be a challenge, as their moods are unpredictable and cause stress and anxiety at home. There are some basic things caregivers can do to not only help your loved ones, but yourselves as well.
With good adherence to treatment and strong caregiver support, it is possible for patients to achieve full remission, with recent studies suggesting that one-third of patients can achieve remission within two years.
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