Bipolar Affective Disorder: Often Overlooked in Pakistan

Introduction

Bipolar Affective Disorder (BAD), commonly known as bipolar disorder, is a complex psychiatric condition characterized by fluctuations in mood. These mood swings range from depressive episodes (low mood) to manic or hypomanic episodes (elevated mood). Let’s delve into the key aspects of BAD.

These fluctuations in mood generally leave patients unable to perform their daily social and functional duties, which directly effects the psychosocial and financial situation of their families. In a country like Pakistan, this burden can be detrimental for a large portion of effected families.

As we shall uncover in the article, Bipolar Affective Disorder is a global mental health problem and is often overlooked in Pakistan with no serious efforts from healthcare institutions for Primary, Secondary or Tertiary preventions. From dire shortages of essential medicines to inadequate indoor facilities for the severely ill patients, the near term prospects look bleak.

Bipolar DIsorder involves extreme fluctuations in mood from Mania (Elation) to Depression (Sadness).

Epidemiology:

• BAD affects approximately 1% of the global population.

• In Pakistan, the prevalence is similar, with a significant burden on public health resources.
  

Global Burden of Disease Study 2019:

• The incidence of bipolar disorder among adolescents and young adults (aged 10–24 years) increased globally from 79.21 per 100,000 population in 1990 to 84.97 per 100,000 population in 2019.

• The average annual percentage change (AAPC) in incidence was 0.24 (95% confidence interval: 0.22 to 0.26).

• Both males and females experienced an increase in incidence, with the largest rise observed in those aged 20–24 years.
  

Mental Health Atlas 2020 Country Profile for Pakistan:

Unfortunately, specific data on bipolar disorder prevalence in Pakistan is not readily available. However, it highlights the importance of mental health awareness and resources.

Local Study:

• Among students in Pakistan, the estimated rate of prevalence for bipolar spectrum disorder (including subthreshold symptoms of hypomania) is approximately 14.3%.

• The estimated rate of prevalence for bipolar spectrum disorder among medical students of Pakistan is 26.84%. There was no significant difference in prevalence on the basis of gender. Prevalence was increasing with both age and class wise distribution. Incidence Rates:

• Incidence rates for bipolar disorder (largely focusing on BD-I) have been estimated at approximately 6.1 per 100,000 person-years (95% confidence interval: 4.7 to 8.1)
  

It is essential to recognize that BAD is almost always recurrent, leading to chronicity and substantial morbidity.

Types of Bipolar Disorder

Bipolar I Disorder (BD-I):

• Characterized by full-blown manic episodes lasting at least one week.

• Often accompanied by major depressive episodes.

• Psychosis may occur during manic episodes.
  

Bipolar II Disorder (BD-II):

• Features hypomanic episodes (less severe than mania) and major depressive episodes.

• Hypomania does not lead to significant impairment or psychosis.

Bipolar III Disorder (BD-III):

• Features Manic/Hypomanic episodes often triggered by different medications

• Usually coincides with the use of certain drugs (Methamphetamine, 'Ice') or medicines (Steroids).

Cyclothymic Disorder:

• A milder form with chronic mood instability (alternating between mild depression and hypomania) lasting for at least two years.

Mania is a core feature of Bipolar Disorder. It makes you feel extremely happy, energetic, grandiose, impulsive and you don't feel the need to sleep for days!

Etiology and Risk Factors

• Genetic factors: Family history plays a crucial role, with a higher risk among first-degree relatives.

• Neurobiological factors: Dysregulation of neurotransmitters (e.g., serotonin, dopamine) contributes to mood instability.

• Stressful life events: Trauma, loss, or chronic stress can trigger episodes.

• Substance abuse: Alcohol, opioids, and stimulants increase the risk.

Clinical Presentation

Manic Episode:

• Elevated mood, increased energy, decreased need for sleep, impulsivity, and grandiosity.

• May involve risky behaviors (e.g., excessive spending, promiscuity).

Depressive Episode:

• Persistent sadness, loss of interest, fatigue, changes in appetite, and suicidal thoughts.

• Impaired concentration and psychomotor agitation or retardation.

Depression in Bipolar Disorder makes you feel very sad, lethargic and suicidal.

Treatment Options

Psychological Interventions:

• Cognitive-Behavioral Therapy (CBT): Helps manage mood swings and improve coping skills.

• Psychoeducation: Educating patients and families about the disorder and its management.

Pharmacotherapy:

• Mood Stabilizers: Lithium, valproate, and carbamazepine.

• Atypical Antipsychotics: Quetiapine, olanzapine, and aripiprazole.

• Antidepressants: For Bipolar Depression. Used cautiously to prevent switching into mania. Often given under cover of Antipsychotics or Mood Stabilizers.

Prognosis

• Early diagnosis and adherence to treatment are crucial.

• With proper management, many individuals with BAD can lead fulfilling lives.

With early management and proper care, patients of Bipolar Disorder can lead normal and fulfilling lives.

It is fundamental for Healthcare organizations in Pakistan to raise awareness about Bipolar Affective Disorder and improve access to mental healthcare services throughout the country so we can curb

Remember that individualized treatment plans are essential, considering the patient’s unique needs and preferences. Collaborate closely with other healthcare professionals to provide comprehensive care.

Disclaimer: This article provides a concise overview and should not replace personalized medical advice. Always consult a healthcare provider for specific recommendations based on individual circumstances.