This article comes from the WeChat public account:Gezhi Lundao Forum (ID: SELFtalks), author: Gan Zhaoyu (third Affiliated hospital psychiatry chief physician), from the head of FIG. pixabay
My clinical work is mainly to deal with the emotional problems of patients or various visitors. We all share joys and sorrows, and we often have all kinds of bad emotions.
I just came back from Wuhan Anti-epidemic more than a month ago. On the first day of work, I came to a girl in her 30s. She told me that she fell into the lowest point of her life in the past two years and experienced many things. Including mothers performing surgery, four elders hospitalized, and one teacher died.
She was very upset. She said that she didn’t want to move, talk, or care about people for two years. Seeing the world was gray, lacking energy, lack of concentration, and often had suicidal thoughts, so she asked for help several times. A doctor. The doctor prescribed a lot of antidepressants to her, but she did not benefit from the antidepressants and her mood has not improved.
Later she read a book of mine and drew this picture. From this picture you can see her life experience in life.
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When she went to kindergarten, her parents divorced, but the divorce of her parents did not seem to have much impact on her emotions; she was always in a good mood in elementary school, and she described her overall primary school It is happy to live a carefree life, but it is only occasionally unpleasant.
In junior high school, she had a period of low mood. At that time, she had the idea of suicide for the first time. She described the low mood at that time for no reason. Later, she experienced a friendly mutiny and her mood suddenly changed again. It fell into the trough.
But when she was in high school, her emotions were on the fast lane again. She described the high school stage as the most beautiful stage of her life. At that time, she was very happy, and she felt extremely happy. It was good to see everything, even the air she exhaled. It’s sweet. It seems that the colors of things are all bright, so she has a very good mood in high school, and her college entrance examination results are also good. She was admitted to college.
But after entering college, her emotions are like a roller coaster. She is basically in a depressed state in winter and spring, but it is not very serious, and she can barely stick to her studies. In summer and autumn, the mood is relatively high, very active, shopping, shopping, shopping, and parties, all do not fall.
This state continued until work, and she fell into the trough in the past two years. She asked me: “Doctor, what is my disease?”
She reminded me of another patient who also drew a picture. He also experienced depression for a long time in the beginning of 2015. The doctor prescribed antidepressants and he took antidepressants. After taking the medicine, my emotions improved immediately and I could enter a very happy state.
In this happy state, he met a womanBoys, they met at the bar, the two sides fell in love at first sight, but this state of love lasted only three or four months, and later quarreled with each other because of three different views, his emotions swing back and forth like a roller coaster again.
Noisy and noisy, and finally broke up, he fell into depression again, but this depression did not last long, and in a very happy state, he felt very good again, so he reunited with his girlfriend and broke up. Together, he broke up with his girlfriend more than ten times in six months. He said he was physically and mentally exhausted. His antidepressants have been eating. He doesn’t know why his emotions are in this state.
He asked me: “What kind of disease is this?” I told him that the disease was “Bipolar disorder“.
The status of “bipolar disorder” and the difficulty of diagnosis
“Bipolar disorder” is a state of hypomanic episodes and depression episodes, like the picture in this picture.
Some people describe the mood of “bipolar disorder” as a roller coaster, which suddenly rises and falls; some people describe it as sitting on a rocker, and the emotions recur between sadness and joy.
We all know “depression”, but “bipolar disorder” is also very common.
In 2019, Professor Huang Yueqin of Beijing Anding Hospital conducted a national epidemiological survey and found that the prevalence of “bipolar disorder” is about 0.5%, which means that based on a population of 1.4 billion, China More than 7 million people have “bipolar disorder”.
In 2011, Shenzhen, China participated in an epidemiological study initiated by the World Health Organization and found that in Shenzhen’s population, the prevalence of “bipolar disorder” is as high as 1.5% The big difference?
We think that bipolar “bipolar disorder” is more common among adolescents, with peak onset between 15 and 19 years old, and peak onset of disability between 25 and 29 years old, which means that the disease often destroys individuals in the cardamom life.
Looking back, why is the incidence rate in Shenzhen higher than in the whole country?
Because Shenzhen is a young city, The population of this city is generally younger than other cities, so its incidence is higher.
The clinical diagnosis and treatment of bipolar disorder “bipolar disorder” is not optimistic. We made a survey in 2007. The first diagnosis of bipolar disorder was found, and the misdiagnosis rate was as high as 90%.
More than half of the patients who received treatment did not stop the drug within half a year without the consent of the doctor. More than 50%, that is to say, many patients did not followFrom treatment.
Why does this happen?
First of all, how is bipolar disorder diagnosed? By definition, bipolar disorder is a type of mood disorder that has both mania and depression attacks, so the clinical diagnosis is mainly based on the doctor’s consultation, through the conversation with the patient and family members, to trace his past experience Do you have a manic or hypomanic episode at the same time, or a depression episode?
Depressive episodes and manic episodes have diagnostic criteria, including symptom criteria and course criteria.
For example, for a depressive episode, at least four of the nine major symptoms must be present for two weeks, while for a manic episode, at least four of the eight major symptoms must be present for at least four days. If the patient has two previous experiences, the diagnosis is biphasic.
It seems very simple to say, but it is actually very difficult to diagnose, why?
First of all, hypomania is like getting drunk, drunk is a gradual process.
No patient took the initiative to find a doctor after drinking and said that I was drunk and gave me some anti-alcoholic medicine. The same is true for manic and hypomanic patients, especially for patients with hypomania who will not seek the help of a doctor , He thinks that state is very good.
Unless the mania reaches an uncontrollable level, it may be escorted and tied up for hospitalization, so hypomania is rarely seen in the clinic.
So, what was the situation like during the depression?
Depressive emotions often cast a shadow on the patient’s cognition, just like wearing sunglasses to see the world. The patient not only sees the world gray, but also the experiences reviewed are gray, so many patients say that in this life I We have never been happy. It is difficult for such patients to ask him whether he has a history of hypomania or mania.
Someone surveyed patients who had been diagnosed with bipolar disorder and asked him if he had been hypomanic or manic in the pastAs a result of a manic episode, the positive rate of the history of mania and hypomania is only 23%, and the ratio is not 1/4, so why is bipolar misdiagnosis, because the history of hypomania is very difficult to ask.
There is another type of patient who is not impatient and the time has not yet arrived. Mania or depression can take a while to show.
Some patients have depressive hair as the first manifestation for the first time. The proportion of these patients in biphasic is about 1/4 or 1/3.
If this type of patient comes to see the doctor for the first time, his mania has not yet arrived. At this time, he can only be diagnosed as depression according to the diagnostic criteria, not as biphasic.
There is another type of patient whose clinical situation is very complex. Many patients are not sick according to standards and textbooks.
A junior high school student came to see me for the first two days. He said that most of his days in each of these two years were depression, but ten minutes between classes was his happiest time. In these ten minutes, He will desperately think back and imagine all kinds of happy things. He runs, jumps and sings in the small garden of the school, and sometimes talks to himself.
But once the class bell rings, his emotions will suddenly fall to a trough, so his mood will fluctuate several times a day.
But the hypomania lasted at least four days, and he failed to meet the diagnostic criteria for hypomania, soHe could not be diagnosed as biphasic, but in fact his emotion is the repeated swing of these two extremes, which is a biphasic.
Is “bipolar disorder” a “genius disease”?
We gave a lot of information to tell the patient that he was biphasic, and many family members and patients could not accept it. Because when it comes to “bipolar disorder”, when it comes to mania, it feels that mania is psychosis, which is hysterical, heartbroken, and irrational. It is a shame.
Actually, biphasic is a very common disease. Many celebrities have had this disease in history, so it’s not lonely to get biphasic. You can be with Van Gogh, Pushkin, Goethe, and you are not ashamed. “Since ancient times, there are many talented people”, it is said that smart people are easy to get bipolar.
I’m not complimenting them. Let’s take a look at the two researches. Let’s look at the U shape first. This is Swedish research. We take 15-16 year-old students as the research object and examine their achievements. Of students and students with low grades have the probability of suffering from bipolar disorder at the age of 17-31.
MacCabe,JH et al. BritishJournal of Psychiatry,2010, pp. 109-15
Studies have found that students with good grades are between 17 and 31 years old, and the risk of getting biphasic is four times that of average grades. Of course, poor grades may also increase the risk a little, but there is no increase like students with good grades. So obvious.
The other picture is a Danish study. The research object is a soldier. When the soldier is enlisted in the military, a math test is done. This test has 1~9 points, 9 points is the highest point, 1 point is the lowest point, and the study found 8~ A soldier with a score of 9 points is 12 times more at risk of biphasic in the next ten years than an average soldier.
Tiihonen, J. et al.. The American Journal of Psychiatry.2005,pp. 1904-10.
Therefore, there is medical evidence for the “many and talented since ancient times”, and it is not a shame to get biphasic.
“Bipolar disorder” needs timely treatment
Although “bipolar disorder” is a genius disease, this disease can be fatal and make mediocre geniuses. Without treatment, the disease will recur repeatedly, and the patient’s social function will be as shown in the picture. Go downhill slowly.
B. Sole, et al. Int J Neuropsychopharmacol 20(2017) 670-680.
In Finland, there is a nationwide study to study bipolar patients who develop onset before the age of 25 to see their unemployment rate, dropout rate, and income between the ages of 25 and 60.
Data sources: C. Hakulinen, KL Musliner, and E. Agerbo, Bipolar disorder and depression in early adulthood and long-term employment, income, and educational attainment: A nationwide cohort study of 2,390,127individuals. Depress Anxiety 36 (2019) 1080-1088.
It is difficult to complete junior high school or above if you do not treat after you have biphasic. In addition, the employment rate is very low, less than 20% of patients can keep a job, and their income also drops significantly. The red part is double The situation of the patient.
Data source: P. Dome, et al. Medicina (Kaunas) 55 (2019).
More terribly, biphasic is fatal if left untreated, and the risk of suicide due to biphasic is 10 to 30 times that of the general population. About 200 to 400 people die of bipolar suicide every 100,000 people every year, so we must pay attention to the treatment of this disease.
Bipolar depression patients will feel depressed, lose interest, and feel tired. Many times people may be morally kidnapped, and even some people will say: “If you want to open up, you always want to die, have you ever thought of your family or parents?”
In fact, the onset of depression is due to functional and physiological problems in the relevant areas of the patient’s brain, which makes him unable to be happy and loses his ability to make himself happy.
depression, which makes the brain lose the ability to be happy
However, bipolar depression will gradually get better after a period of time, so family members think that the disease will not get cured, it will gradually get better, and it will pass after a long time, so the disease is often from onset to treatment It takes a long time, the reason is here.
“Mania” is like speeding. Some patients get on the fast lane all at once, and some people accelerate slowly. The process is unconscious.
Once on the fast lane, the patient will feel very refreshed, energetic, agile, confident, and passionate. Some people can continue to sleep for a few days without feeling tired for only an hour or two a day. And they are very aggressive in their work and will set ambitious goals and talk about vigorous love.
One of my patients said that he only looked at a photo of a girl and decided to pursue her. A girl said that she only listened to the live broadcast of a boy’s online voice, and she didn’t see a real person. She said that I was determined to be the boy, but these relationships come and go quickly.
This mania is not sustainable. It overdraws the patient’s energy, wealth, their future, feelings and even life in advance.
In a manic situation, the patient will take risks and do very exciting things, such as mountain climbing and extreme sports. In the process, he may lose his life.
So mania seems beautiful, especially in this age of eagerness for success, everyone hopes that they have always maintained a state of hypomania, a very passionate state, but in fact this is not scientific, this After this mania, it is often followed by a depression.
This depression episode is not the same as general depression. It is difficult to benefit from antidepressant treatment, and even antidepressant treatment is harmful to it.
Even if some patients take antidepressants, they will soon work, but that is not really effective. After taking antidepressants, some patients feel that their emotions are not real, and that laughter is not heartfelt happiness. . Some patients took three or four kinds of this medicine, and they did not get any effect from them.
Some patients need to keep increasing their doses after taking antidepressants to feel a little bit happy. Some patients become more irritable and irritable after taking the medicine, and even have more intense suicidal thoughts. There are also some patients who take antidepressants, and their emotions are like accelerated roller coasters, with several back and forth during the day.
So why should you distinguish between depression and bipolar depression? Because its treatment is different.
The ineffectiveness of antidepressant treatment often makes patients lose confidence in the treatment. In fact, it is not that it is ineffective, but because the diagnosis is wrong and the wrong prescription is given, so there is no effect.
How to treat “bipolar disorder”?
So, how to treat bipolar in daily life?
For a first-time patient, if his condition is serious, I generally recommend that he be hospitalized, after about two weeks, and then insist on outpatient follow-up.
After five years of follow-up, 18% of the patients were completely healed, and more than half of the patients were partially healed. The symptoms were basically controlled. Although there are some residual symptoms, about 25% of the patients are recurrent or chronic. status.
So, This disease can be cured, but it does have a tendency to recur and become chronic, so we must pay great attention to its treatment.
Although the disease recurs repeatedly, it is possible to get married and have children.
This is a patient I have been with for more than ten years. From the onset of her university, to the end of her work, she has followed me. She also cut off several medicines, repeated several times, and finally entered the palace of marriage.
She sent me a WeChat on the day of her marriage and told me: “Professor Gan, I am married, thank you for your support and help for many years.” I replied to her: “Must insist on taking medicine, especially in the newly-married stage, medicine is not only to protect yourself, but also the biggest escort to marriage.”
Why take medicine? Because the treatment of bipolar disorder, the most important means is drug treatment, because bipolarity is actually a physiological disease.
A.Perry, et al, Connectomics of bipolar disorder: a critical review, and evidence for dynamic instabilitieswithin interoceptivenetworks. Mol Psychiatry 24 (2019) 1296-1318.
It can be seen from the results of functional magnetic resonance imaging that the blue areas of the brain have functional decline and volume reduction. These areas are responsible for our emotions, cognition, attention, and executive functions, while the red part is related to function. Adjustment, execution and operation.
It can be seen from these figures that biphasic is caused by pathological and physiological changes in the brain, and drugs have the function of reversing pathological changes.Cell repair, and can make all areas of the nerve, especially the areas such as the frontal cortex hippocampus increase in volume, play a role in repairing nerves.
So I told a lot of patients that this medicine is a brain tonic. As long as the treatment is maintained, it can prevent the disease from recurring repeatedly, so be sure to stick to it.
How long do you eat? It varies from person to person.
Every attack is like a fracture. The first treatment is critical. Sufficient and continuous treatment makes the nerve repair complete and prevents future relapses.
Like a fracture, some patients may only need a short bandage, adjustment, and rest. Some may have to use a cane and cast a few months to recover, while others need to fight for life. You can live with steel nails, which is different from person to person.
So be sure to decide the course of treatment under the guidance of a doctor, so that the treatment continues to be in a very stable state.
I remember a few years ago, there was a professor at Yale University who was also troubled by “bipolar disorder”. At the beginning, the treatment was very irregular, and the medicine was always cut off. The result was repeated, and he recovered in the last few decades. To take medicine.
Later, a reporter asked him: “Although you break the medicine and it is easy to relapse, shouldn’t you work hard again?” He said: “Life is short, and now you want me to waste another year to experience the recovery The healthy process is too costly. Everyone’s life is just like this, to work and to love, to work and love.”
Why do we all do this? Because Freud once said: “To maintain physical and mental health, there are only two ways, one is to work hard and the other is to love someone.”
Freud
Why work hard and love your lover is a good way to maintain physical and mental health?
Because keeping work not only gives you financial and financial freedom, but also gives you a sense of psychological accomplishment and satisfaction.
Loving someone well will make you reduce interpersonal conflicts, reduce all kinds of interpersonal pressures, and let you enjoy the feeling of love.
Bipolar disorder patients or “bipolar disorder” patients often have stronger personalities, longing for success, pursuing perfection, and pursuing self-improvement. They all hope to have a vigorous life.
But as Yang Jiang said: “We were so eager for the waves of fate, only to find out at the end: the most beautiful scenery in life is actually the calmness and calmness of the heart.”
For patients with bipolar disorder, I also give this sentence to them, don’t pursue the passionate state of mania and hypomania, because that state is unsustainable and plain. It is the life we should have.
This article comes from the WeChat public account:Gezhi Lundao Forum (ID: SELFtalks), author: Gan Zhaoyu (third Affiliated hospital of Zhongshan University psychiatric chief physician)