My well-behaved and sensible daughter seemed like a different person overnight. What happened?

Author: Gao Chang, Director and Associate Professor, Jining Medical College

Reviewer: Zhang Zhiyong, Chief Physician, The Second Affiliated Hospital of Xinxiang Medical College

Lingling, the only child, has been cute and well-behaved since she was young. After her parents get off work, Lingling always serves tea and water in time, asking about their well-being. She is the "little cotton-padded jacket" in her parents' hearts. But recently, Lingling has been acting out of character, either talking back to her parents or damaging bed sheets, quilt covers and other household items, often venting her dissatisfaction and showing various signs of illness. Her family rushed her to the hospital for treatment.

The doctor diagnosed that Lingling suffers from bipolar disorder and is currently experiencing a manic episode with psychotic symptoms.

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What is Bipolar Disorder

Bipolar disorder is a constant shift between two mood states (depression and mania). Compared to unipolar disorder, it is actually a swing back and forth between depression and mania[1]. In the early stages of the disease, the patient is only mildly depressed and in a low mood, with a sad face or sighing.

As time goes by, coupled with the lack of adaptability to the work environment and increasing pressure, the patient becomes increasingly anxious and restless, often in a manic state, which may lead to verbal conflicts with others or smashing things, gradually developing bipolar disorder.

Like depression, bipolar disorder is a common and frequently occurring psychiatric disease, characterized by high prevalence, high relapse rate, high disability rate, and high comorbidity rate [1].

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Clinical symptoms of bipolar disorder

The clinical manifestations of bipolar disorder are manic episodes or alternating episodes of depression and mania. The patient's manic episodes are characterized by the "three highs" symptoms of high mood, racing thoughts, and enhanced will and behavior, which belong to psychomotor excitement.

1. Manic episodes

(1) Emotional agitation : Patients are sometimes particularly easily irritated and lose their temper over trivial matters. When the condition is serious, they may speak and act impulsively. As a result, the relationship between patients and their families often reaches a deadlock.

(2) Fleeting thoughts : The patient's thoughts are flexible, and the speed of speech is obviously faster than usual, and the volume is much higher than usual. The patient often speaks with a dry mouth and a dry tongue. When the disease is serious, the patient speaks without restraint and speaks in an outrageous manner, even to the point of delusion.

(3) Enhanced will and behavior : The patient is busy all day long, likes to meddle in other people’s affairs, acts impulsively, has no conclusion, and does not consider the consequences.

2. Alternating episodes of depression and mania. The patient is hostile to the relatives around him, sometimes feeling despair and depression from the bottom of his heart, and sometimes becoming manic and restless, and having conflicts with his relatives. If something goes wrong, even if it is a verbal disagreement, he will ignore it, speak rudely, and destroy bed sheets, quilt covers, curtains and other items...

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Causes of bipolar disorder

So, what exactly causes this disease? A large amount of research data shows that genetic factors, biological factors, psychosocial factors, etc. all have a very obvious impact on the occurrence of bipolar disorder, and the interaction between them can lead to the occurrence and development of the disease.

1. Genetic factors Families with genetic genes have a much higher incidence rate than ordinary families. Lingling, mentioned earlier, has healthy parents, but her grandmother suffers from schizophrenia, which is one of the reasons for her illness.

2. Environmental factors: As the patient's surrounding environment deteriorates, they gradually begin to experience tension in their interpersonal relationships. They do not approve of themselves, do not accept criticism, and instead feel resentful[1].

3. Drug factors Some drugs used to treat depression can also increase the transition between the two conditions of bipolar disorder. For example, taking antidepressants during depression may trigger a manic episode in patients [1]. If a patient is suffering from depression, psychological counseling and low-dose antidepressants may be given to the patient. If the patient relapses, re-taking the drugs may lead to a manic episode.

4. Climate factors The change of seasons, such as winter to spring and summer to autumn, are factors that trigger bipolar disorder [1].

Bipolar disorder is a highly disabling mental illness that must be treated promptly.

In response to Lingling's situation, after Lingling was admitted to the hospital, the doctor adopted a combination medication approach, namely giving her 700 mg of quetiapine tablets and 0.6 g of lithium carbonate sustained-release tablets every day, and at the same time gave her cognitive therapy.

After the above treatment, Lingling's diet returned to normal, she often did not get enough sleep at night, there was no abnormality in her urination and defecation, and her weight did not change much after she became ill. Although she still had obvious language and behavioral impulses, she no longer had negative words and behaviors.

After 30 days of hospitalization, Lingling was discharged. When she was discharged, her mood became more stable, she could clearly recognize the mistakes of her previous thoughts, correctly evaluate herself and others, and cooperated with the treatment seriously.

From the above introduction, we can know that when bipolar disorder occurs, it will seriously damage one's physical health, affect one's own cognitive level, and easily cause harm to loved ones, leaving too many regrets. Therefore, early detection, early treatment, and early prevention are necessary.

References

[1] Katie Konigbel. Surviving Bipolar Disorder: An Everyday Guide to Coping with Manic-Depressive Life. Translated by Zhang Qing. Beijing: CITIC Publishing Group, 2022.