Monday, June 22, 2020

Pay attention to bipolar disorder with the highest suicide rate

March 30 is World Bipolar Disorder Day. When it comes to "Bipolar Disorder", many people may not understand it, and haven't even heard of it. In fact, many political and cultural celebrities in history, such as Churchill, Lincoln, Van Gogh, Hemingway, Marilyn Monroe, etc. have suffered from this disease.

Bipolar disorder is a type of mood disorder. The reason why it is called “biphasic” refers to the fact that patients have both manic and depressive episodes. In popular terms, they are emotionally upset and sad, so bipolar disorder is also It is called "bipolar disorder" and "emotional seesaw".

What is bipolar disorder? Mania + depression Bipolar disorder refers to a type of mood disorder that has both manic or hypomanic episodes and depression episodes. Unlike the emotional ups and downs that everyone will experience, bipolar disorder has greater emotional ups and downs, with severe depression and mania. When the manic episode occurs, it is characterized by high emotions, increased interest and motivation, and increased speech and behavior; while during the episode of depression, the core symptoms of depressed mood, decreased interest, fatigue, and delayed thinking and other symptoms appear. Bipolar disorder generally presents with a seizure course, and mania and depression often appear in various forms such as repeated cycles, alternating reciprocation, or irregularity. Mixed episodes of depression and mania can also occur. The manic episode lasted for more than 1 week, the mild manic episode lasted for more than 4 days, and the depression episode lasted for more than 2 weeks, which had an adverse effect on the patient's daily life and social function. According to statistics from the World Health Organization, the global average incidence of bipolar disorder is 2%-3%, and in some countries or regions it can be as high as 5%-7%. Bipolar disorder mainly occurs in early adulthood. Looking at the survey data at home and abroad, most patients have an age of onset between 20-30 years old, and the incidence is more common before the age of 25. The peak age of onset is concentrated at 15-19 years old. In China, patients with bipolar disorder account for 1%-1.5% of the total number of patients with various mental disorders.

How to identify bipolar affective disorder? Early recognition is the key to early recognition of bipolar disorder is particularly important. Because the diagnosis of mental and mental diseases can not be resorted to laboratory testing alone, it mainly depends on the observation of the patient. If it is found that the people around him have moody manifestations, they can initially determine whether he has the possibility of bipolar disorder from the following four aspects: 1. Depression and mania. Depressed, depressed or sorrowful during depression episodes, uninterested, fatigued, negative inferiority complex, brain unresponsiveness, etc.; manic episodes, quick response, increased speech, surging, feeling good about yourself, nosy, behavior Reckless impulse, etc. 2. Depression performance lasts for more than two weeks, mania performance lasts for more than one week, and depression and mania manifest for most of the day. 3. Career and social functions are obviously affected, patients feel pain or cause trouble to others. For example, it is difficult to maintain school and cannot continue to work. 4. Need to rule out certain physical diseases and emotional abnormalities caused by drugs and drugs.

What are the difficulties in diagnosing bipolar disorder? Symptom identification + course recognition of mania/depression repeated and alternating episode evidence is the main basis for diagnosing bipolar disorder. Accurate diagnosis depends more on the understanding of the nature of "mood instability" and an in-depth understanding of volatility and episodes. Both symptom recognition and course recognition are equally important. The key to early recognition of bipolar disorder. The first is the importance and recognition of hypomanic episodes. Many clinical hypomanic episodes are not due to the low level of recognition by doctors, but are not given enough attention, and are not questioned or omitted during the consultation. The second is to make full use of the clinical features of bipolar depression. Compared with patients with unipolar depression, patients with bipolar depression have a relatively young age of first episode of depression (such as <25 years old, rapid depression episodes, frequent or frequent episodes of depression, high probability of psychotic symptoms, and atypical depression symptoms) High, prone to refractory depression, easy to reverse phase in antidepressant treatment, relatively common or severe suicide, common comorbid anxiety disorder, common comorbid psychoactive substance use, positive family history of bipolar disorder, etc. The third is Bipolar disorder and comorbid diseases (such as ADHD, anxiety disorder, personality disorder, psychoactive substance abuse, etc.) overlap and interact with each other, increasing the difficulty of diagnosis, confusing clinicians, and causing missed diagnosis of bipolar disorder. The fourth is to correctly understand the partner of emotional attack Some psychotic symptoms. Diagnosis and treatment of bipolar disorder are generally more difficult than unipolar depression, so you must find a professional doctor.

Is bipolar disorder the mental disorder with the highest suicide rate? According to statistics, the risk of suicide in patients with bipolar disorder is 10 times that of the general population, 25-50% of patients with bipolar disorder have committed suicide, 11-19% committed suicide, young The first year after the patient's first diagnosis is particularly prone to suicide. A large sample clinical survey found that among patients diagnosed with bipolar disorder at the first hospitalization, the male suicide risk was 8% and the female was 5%, ranking first among all mental illnesses. Suicide may occur in various stages of bipolar disorder. Patients have a higher risk of suicide when they are depressed or mixed, and lower when they are manic. In recent years, studies have shown that when patients are in a general mixed state, namely inferiority complex, hopelessness, excessive self-blame, irritability, etc., will lead to a higher risk of self-mutilation. Other important risk factors include the first episode of depression and rapid circulation attacks.

What are the treatment methods for bipolar disorder? Pay attention to the "three principles". Because bipolar disorder is a recurrent disease, it is necessary to emphasize long-term preventive treatment. The preferred long-term management strategy is the combination of medication and psychotherapy. The treatment of patients with bipolar disorder needs to pay attention to the "three principles": the comprehensive principle, the long-term principle, and the principle of patient and family participation. The comprehensive principle refers to the use of multiple means, such as psychotropic drugs, physical therapy, psychotherapy, and crisis intervention, to comprehensively use it to improve the efficacy; the long-term principle refers to the need for patients to follow the doctor’s long-term treatment to achieve coexistence with the disease and improve the quality of life; patients The principle of joint participation with family members is to encourage family members to participate in the patient's treatment process, help patients to improve compliance, and reduce relapse.

At present, drug therapy (including mood stabilizers, antipsychotic drugs, and antidepressant drugs) is still the main method for the treatment of bipolar disorder, and mood stabilizers are the internationally recognized main therapeutic drugs, from the acute phase to the consolidation and maintenance phase The main choice. In addition, making tables that record daily emotional conditions, treatment, sleep patterns, and life events can help patients and their families better understand the disease. This form can also help doctors track and treat diseases more effectively.

Patients with bipolar disorder should receive guidance and treatment from a psychiatrist. Other mental health experts, such as psychologists, psychiatric social workers, and psychiatric nurses, can help provide patients and their families with additional treatments. People with bipolar disorder need strong encouragement from family and friends to seek treatment. Sometimes, family members or friends need to take bipolar patients for proper mental health examination and treatment. If during a severe attack, the patient needs to be hospitalized to ensure his safety and receive adequate treatment. After the patient receives treatment, continuous encouragement and support is needed, because for each individual, it may take some time to find the best treatment plan.

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