When it comes to diagnosing a Bipolar Disorder , there is often a lot of disbelief in the patient (much less in the patient’s family members who, in the descriptions that the doctor makes of their family member, find themselves fully).
This is a common phrase from bipolar disorder sufferers:
“Doctor, I have bipolar disorder
I have never been manic in my life. You’re wrong, I’m a chronic depressed person! ”
The importance of this sentence is underestimated. Because this sentence itself, if you like, is a symptom, one of the ways in which the disease presents itself. Often those who have bipolar disorder when they are depressed believe they have always been depressed and will never recover, while when they are in the expansion phase (from the more attenuated – hypomanic, up to the more explosive – manic phases) they believe they have never been ill. and to never get sick (it is no coincidence that often in this phase, patients want to suspend the medicines or even stop them autonomously).
What are the expansion phases characterized by? It is
difficult to give a single and univocal picture. An old adage says: “nothing is lasting in mania if not perpetual transformation”.
The expansive phases are characterized, in addition to an increase in energy levels and activity, by a euphoric or irritable mood – often there is a certain instability and the patient passes from jubilation to intense anger -, by a tendency to chat more, from a tendency to spend more easily, from a feeling of subjective well-being, of vitality, of reduced need for sleep (the wife of the patient who has bipolar disorder notices that her husband is expanding from the way she slices bread in the evening , because vitality has changed), also by a more or less progressive, more or less total loss of the ” awareness of illness “.
While the most severe phases, the manic ones, are easily recognizable because the patient is out of control, uninhibited, etc. the more attenuated ones are confused with normality, they are variants full of optimism and vitality of normality. But it is important to recognize them, because the fire of these phases extinguished, the ash that remains and the depression.
I report the data of a study that appeared a few days ago, 6 October 2015, and published in the “International Journal of Bipolar Disorders” (1). Out of 40 patients interviewed with bipolar disorder (confirmed clinically and with diagnostic tests such as SCID I), 82% acknowledged having had a depressive episode in their life.
Only a minority, 22%, acknowledged having had a (hypo) manic episode, and an even smaller number, 17%, but I would say too much, turned to a health worker when they were in an expansion phase. of hyperactivity, of pathological energy increase.
We see patients with an expansive phase everywhere, on TV, in rallies, hardly in psychiatric clinics.
This means that if we ask a patient with bipolar disorder if they have ever had an expansionary phase, they will almost certainly say no. But this should not authorize us to believe that in reality this is the case. Psychiatric diagnoses are inferential, they are deduced from the “implementation” of the symptoms, not from their explanation during an interview. If we wait for Napoleon to confess to us a manic phase (assuming he had bipolar disorder, as has been repeatedly suggested), we will delay in making a diagnosis and we will have lost the first battle of a disorder that is all the more undiagnosed, much more it weighs heavily on the lives of these people.
Source:
1) Regeer EJ et al. Low self-recognition and awareness of past hypomanic and manic episodes in the general population. Int J Bipolar Disorder 2015 Oct 6
