Transcript of
Bipolar disorder
I'm John Geddes.
I'm a professor of epidemiological psychiatry
at the Warneford Hospital in Oxford.
Bipolar disorder is a mood disorder.
It affects the way we feel, so whether we're happy or we're sad.
With bipolar disorder, patients or people who suffer from it,
either have elevated moods.
In other words, they're abnormally happy, but sometimes irritable,
very overactive, full of energy,
which sounds good but in bipolar disorder it gets so intense
that it can become a real problem for the patients.
They might end up spending a lot of money,
or taking a lot of activities on that they can't complete.
The other side of the disorder is people suffer from very low mood.
This is depression, which stops people from functioning.
It means they're not sleeping, not able to become active,
not do their normal activities.
One of the key things in bipolar disorder
is that most patients suffer from both elevated and depressed mood.
So quite often it can be very difficult to manage life.
They never know whether they're going to be depressed or elevated.
If I'd recently been diagnosed with bipolar disorder,
I'd want to ask my doctor about how one reaches that diagnosis,
how I can be sure that is the diagnosis.
I'd want to know about what I might be able to do about it.
Are there any treatments
that can make the course of the illness better?
Is there anything I can do myself to make it better?
We make a diagnosis of bipolar disorder,
mainly on the history but also the examination.
The doctor conducting the diagnostic interview
will be looking at the behaviour of the person in front of them.
There's no diagnostic test like brain imaging or blood test
that one could do for bipolar disorder.
So one really needs to look at the nature of the symptoms,
and how they've affected the person, and the severity of them.
Treatment of bipolar disorder varies a lot from one patient to another,
and it really comes under several domains.
It's not as if we can just usually give a tablet,
or a particular form of psychological treatment.
Often the treatment of any person with bipolar disorder
has to take into account psychological factors.
That often includes medication.
It may include work with family or relatives
to get them to understand the disorder as well.
Underlining the whole thing, really, is that the individual patient
needs to make sure they know as much about the disorder
and the way if affects them so they can access care appropriately,
and use treatments in a way that's best for them.
Amongst drug treatments, probably the best established is lithium therapy,
which, obviously, is widely known,
but it is the drug that's got the very best evidence,
in terms of reducing relapses.
It's best in terms of reducing the manic side of the illness,
and it's less effective overall for the depressive relapses.
Then, of course, there's psychological treatments.
Some patients benefit from cognitive behaviour therapy.
There are other forms of psychotherapy, such as family-centred psychotherapy
or psychoeducation, or, indeed, an interpersonal and social rhythm therapy,
which is more concerned with the relationships with other people,
and the way the person manages their rhythms, such as sleeping and eating.
The impact of bipolar disorder is life-long.
In fact, the World Health Organisation
have found it to be one of the most important causes of disability,
because it affects people during
their most important periods of their working lives.
Recovery does happen in bipolar disorder.
Rather than a complete absence of any symptom of mood disorder,
what seems to happen more
is that people learn how to cope with the disorder,
minimise the amount of treatment they take, but take it appropriately,
and therefore very much reduce the negative impact
that the disorder has on their ability to function in life itself.
So, for example, they might still have some mood variability,
but the severity will be less.
Recovery will usually occur both by taking the available treatments,
finding out what does work for you,
and making sure you take as little as you can,
but taking enough to make the difference.
