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In the last post, we saw how:
Psychosis and melancholic characteristics are two of the specifiers for BAD.
Manic episodes may signify many things in mood disorders, or they may indicate that the condition is not a mood disorder at all.
- Lithium is the prototypical mood regulator.
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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for two consecutive months. This month will be dedicated to BAD or Bipolar Affective Disorder. In the first month, we discussed Depression, and in the subsequent month, anxiety. We are done looking at Twitter Posts and now we are moving to Tic Tok posts.
Announcement!!!
We are moving to our new account after this month's topic. Follow us here
In this post, we are looking at this tweet that talks about BaD in Relationships. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
Patients who are bipolar have these major depressive episodes and manic episodes. Mood disorders are also called affective disorders 2 months ago, we talked about depression, among the types of depression is Major Depressive Disorder which is otherwise known as unipolar depression.
Specifiers
Atypical Features- In order for atypical features to exist there had to have been features that were generally more common in BAD. Take depression, for example, overeating and oversleeping are the exact opposite of the typical insomnia and loss of appetite. Psychiatrists have referred to this as reverse vegetative symptoms. This is also known as hysteroid dysphoria. Atypical features are usually seen in younger patients, they present with psychomotor slowdown and it comes with panic anxiety, abuse of substances and somatization disorder.
Because these mood disorders more commonly come with anxiety disorders they are sometimes wrongly diagnosed as anxiety disorders. The condition may also mimic a seasonal course.
Catatonic Features- Catatonia is more commonly seen in schizophrenia but it can also be seen in mood disorders. Those who have catatonia have a prognostic significance.
The hallmark symptoms of catatonia—stuporousness, blunted affect, extreme
withdrawal, negativism, and marked psychomotor retardation
This is usually seen in every form of schizophrenia, major depression and other neurologic conditions. Typically the features are not attributed to BAD because of mania’s distinct features. Catatonia’s features are seen in many psychiatric conditions so its features are not a diagnosis of the condition.
BAD in Relationships
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Kaplan does not give much explanation about what is expected in a relationship with a person if they are BAD. This is because Kaplan is purely an academic book. But Hopkinsmedicine explains much of the discussion here.
Relationships are challenging as they are but being in tune with someone who is bipolar can present its own peculiar risks.
Intimacy
Starting from Intimacy, you start to see that there is a different dynamics in the behaviour shown. When the patient has a manic episode, they may frequently request sex. This may either be an increased rate of request for sex, or they may choose to masturbate more often or they may more likely to watch porn more.
They are also the danger of them having extramarital affairs (unsafe forms).
When the patient is experiencing a depressive episode, they will not feel like having sex and they may also project during this phase, blaming the partner for manic behaviours. The drugs used in the depressive phases are also known to reduce sex drive.
At work the patient may have issues too and as a partner, it is important to keep this in mind. The patient will go through extremes in behaviour from the depressive melancholic features to the manic phase where they will be easily excitable. Sometimes the work may create more problematic situations for the patient because the stressful job can precipitate symptoms and may keep them out of work.
Similar to work, the stress of parenting can also make depressive or manic episodes more common.
This poses a peculiar problem for children who look for direction from their parents. Having a partner with BAD is very important for this reason.
Going to get counselling as a couple can help the partner deal with some of the pain that may have been caused by the patient’s actions.
At counselling, you will learn that:
The illness is most likely responsible for the awful behaviour. Forging them is a recognition of the influence the condition has had on them. Clear dos and don’t that the patient should be responsible for.
Being a part of the treatment will include escorts to the doctor's office and this will help you give extra features that the doctor may not be able to get from the patient because they do not remember all of their actions. You will learn more about the illness from the psychiatrist. You will learn to make the best decision based on the specific episode the patient is having. You can also give the doctor direct feed about the patient's current behaviour.
Not being a part of the patient's care as a partner might mean that the doctor may not be able to help in an acute presentation.
You need to also take care of yourself patients' care can be very stressful and taking care of yourself can affect the way the patient is cared for in return.
Tips for treatment
Valproate which comes under the brand names Depakene or Depakote does better than lithium in the treatment of acute manic episodes. Lithium can be used for prophylaxis but Valproate functions mostly for acute mania. Doe is usually between 750 to 2500 mg per day, and the blood levels are kept between 50 to 120 micrograms per mil. On day one the patient is loaded with 15 to 20 milligrams or kilograms and it has been associated with quick response.
Hive Stories
Read this post here
Questions
- What did you learn about mood disorders?
- What did you learn about Bipolar disorder?
- What did you learn about the use of lithium?
Conclusion
Among the mood specifiers are Atypical features and Catatonia features.
Couples therapy is probably the most important thing a partner of a patient with BAD can do to help the situation.
Valproic acid is an antiepileptic drug used for acute mood stabilization
I hope that you learned a lot from this post.
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References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
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