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With treatment, the outcome, in general, is good. Without treatment, on the other hand, the outcome is almost always very negative, with constant relapses and serious family, occupational, and social consequences.
Generally, although there are exceptions, the illness develops imperceptibly during adolescence, a stage already known for its proclivity to emotional instability, and reaches its splendour in adult age, in the form of a depressive or even a hypomanic/manic phase.
Very often, the first episode is preceded by a stressing environmental situation. However, from then on, the illness becomes independent of the environmental and psychological circumstances, as such that the biological mood regulator mechanisms seem to enter into a permanent fluctuation, which leads the individuals to lose the point of reference of their usual mood state.
Each relapse makes the individual more vulnerable to stress, as such that, some patients, can begin to present with so-called “rapid cycling”, which is the uninterrupted succession of depression and euphoria (by convention, those that have 4 or more episodes per year are included in this sub-group).
Bipolar disorder is only slightly more common in women than in men, but rapid cycling is a lot more common in female patients. However, rapid cycling can be reversed with suitable treatment.
There is a sub-group of patients that have in common the tendency to always relapse around the same time. For this reason, meteorological factors play a part in the regulation of mood. The most frequent seasonal pattern is the one that has a depressive phase in spring, a manic or hypomanic phase in summer, and a new depression in autumn. It seems that one of the most important meteorological factors is the brightness of the day and its duration. Some of these patients improve the depression by travelling to tropical countries and for some the change triggers a manic phase.
Furthermore, it is important to highlight that there is a sub-group of patients that, in parallel with the mood symptoms, have a gradual decrease in their cognitive abilities and functional performance. This is more common in those cases in which the progression is more problematical, with frequent and severe relapses. In these cases, there are psychotherapy treatments—cognitive and functional rehabilitation—which could be a help in partially recovering these functions.
Consequences of bipolar disorder
Treatment is the determining factor in order to prevent the main complications of the disorder, in which one of the most serious is suicide.
Suicide occurs, generally in the context of a deep depression phases or mixed phases. The persons affected have the feeling that their life has no meaning, they feel a failure and useless and sincerely think that their disappearance will be a relief for them and for those around them. As they have lost the ability to enjoy, they feel that their life is empty and that is not worthwhile. It is very difficult to make a person in such a state to understand that their dramatic vision of things is produced by an illness and that, with treatment, in a few weeks they will recover the objectivity and will forget the wish to die. It is estimated that 15% of patients with bipolar disorder die from suicide. The failed attempts rate is much higher.
Another serious complication that some patients have is drug abuse. Stimulants, like cocaine or amphetamines, provide momentary relief, although destructive in the medium and long term, from the depressive symptoms. Alcohol is, for others, a way to escape from the anguish that regularly accompanies depression. When a patient with bipolar disorder falls into drug abuse or dependence, it adds one illness more to what they already have, affecting the response to treatment and the prognosis of the disorder.
One of the common consequences of a euphoria phase are also the marital/family conflicts. Very often, the lack of knowledge by the partner or family of the pathological character of the behaviour leads to thinking that it is voluntary and free. In other cases, although knowing the illness, it makes it too much to bear, and the couple separate. When patients are very young and live with their parents, these often over-react by overprotecting them and limiting their personal freedom.
The loss of their job, business degradation or ruin are also consequences of the disorder if it is not treated in time. The euphoria leads to taking excessive risks and spending more money than they have; the depression involves sick leave and an obvious decrease in productivity.
Socially, the stigma that surrounds psychiatric disorders causes notable harm to the patient on not being able to talk naturally about the disorder, as happens with other diseases like osteoarthritis or a high cholesterol.
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Substantiated information by:
Ana Isabel Martínez AránPsychologyPsychiatry and Psychology Department
Diego Alberto Hidalgo MazzeiPsychiatristPsychiatry and Psychology Department
Eduard Vieta PascualPsychiatristPsychiatry and Psychology Head of Department
Mercè Comes ForasteroNurse Specialist in Mental HealthPsychiatry and Psychology Department
Published: 20 March 2018
Updated: 20 March 2018
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