What is the ICD of bipolar disorder?
In the International Classification of Diseases ( ICD 10 ), bipolar affective disorder can be found under the codes:
- F31.0 : Bipolar affective disorder, current hypomanic episode;
- F31.1 : Bipolar affective disorder, current manic episode without psychotic symptoms;
- F31.2 : Bipolar affective disorder, current manic episode with psychotic symptoms;
- F31.3 : Bipolar affective disorder, current episode of mild or moderate depression;
- F31.4 : Bipolar affective disorder, current severe depressive episode without psychotic symptoms;
- F31.5 : Bipolar affective disorder, current severe depressive episode with psychotic symptoms;
- F31.6 : Bipolar affective disorder, current mixed episode;
- F31.7 : Bipolar affective disorder, currently in remission;
- F31.8 : Other bipolar affective disorders;
- F31.9 : Bipolar affective disorder, unspecified.
Index – in this article you will find the following information:
- What is Bipolar Disorder?
- What is the ICD of bipolar disorder?
- Nature of the episodes
- Types of Bipolarity
- Causes and risk factors
- What are the symptoms of affective bipolar disorder?
- Symptoms in children and adolescents
- Diagnosis
- Comorbidities
- Is Bipolar Disorder Cure?
- What is the treatment?
- Medicines
- How to live together
- Complications
- Prevention
Nature of the episodes
In general, people believe that patients who suffer from bipolar disorder experience episodes of joy and sadness. In fact, there are different episodes, with different symptoms, that can be fitted into the bipolar spectrum.
- Mania: Mania is a state in which the person is euphoric and more irritable. It may be accompanied by psychotic symptoms and disrupt the patient’s daily life;
- Hypomania: Also characterized by euphoria and irritation, but there are no psychotic symptoms.
- Depression: It can be very similar to major depression, in which the person feels a deep sadness for no apparent reason, which can incapacitate him, or it can be more like dysthymia, a type of depression in which the patient feels a chronic sadness, but it does not make it impossible for him to carry out his usual activities, even if he does not see the point.
There is not necessarily a pattern, as some people may experience more episodes of hypomania than mania itself, others face episodes of dysthymia rather than depression and others may never experience complete mania.
Types of Bipolarity
The disorder can be classified into four groups, according to the patterns of mood swings. Are they:
Bipolar type I
For DSM-5 (5th edition of the Diagnostic and Statistical Manual of Mental Disorders), type I bipolar disorder is an updated reading of what, before, was understood as a classic manic-depressive disorder or affective psychosis differentiating itself because there is no need of the patient experiencing psychosis or major depressive episode.
Bipolar type II
Predominance of depressive episodes, with incidence of hypomanic episodes, that is, episodes of a kind of milder mania, which does not prevent the person from working or studying, without psychotic symptoms. However, attention during depressive episodes should be increased.
Cyclothymia
Characterized by the oscillating presence of depressive symptoms and hypomania for a period of at least 2 years. However, the symptoms are not enough to configure depressive or hypomanic episodes themselves, therefore, being classified as another type of disorder.
Bipolar disorder, unspecified
The categorical diagnosis is based on the criteria indicated in the DSM-5 and the ICD-10 to characterize bipolar disorder. These are the cases in which the symptoms do not fit the criteria of types I or II.
While in type I bipolar disorder there are manic and / or hypomanic symptoms, type II presents only the hypomanic. Therefore, the unspecified type comprises symptoms that do not meet all the criteria stipulated for types I and II.
There may be hypomanic episodes of short duration (less than 4 days), rapid cycles – when oscillations occur in less than a week – recurrence of atypical mixed states, among others.
Previous versions of DSM-5 established stricter categories for the diagnosis of disorders, without considering the symptomatic dimension. However, the 5th version made the classifications more flexible and started to consider that some symptoms may be similar and share risk factors, being possible to group them in a spectrum (bipolar spectrum).
In this sense, the dimensional approach to psychiatric disorders considers symptoms as possible variations of personality. For the dimensional assessment of the patient, the professional observes how close the picture is to each spectrum, making an escalation or score for the diagnosis.
Causes and risk factors
As with many other psychiatric conditions, it is difficult to trace a single cause that triggers Bipolar Affective Disorder. There is evidence that there are both genetic and psychosocial causes.
Genetics and family history
Experts suggest that genetics has some connection with the development of the disease, but studies in identical twins have shown that the two do not always develop the disease.
However, it remains a fact that most people affected by bipolar disorder have the disease in their family history.
Brain structure and functioning
There are studies that reveal that the brains of bipolar patients have some changes compared to the brains of healthy people or with other psychiatric disorders. The differences can be both physical and chemical, related to neurotransmitters.
Substance abuse
The use of substances such as alcohol, tobacco and other illicit drugs can cause mental confusion and trigger various behaviors and feelings characteristic of episodes of mania or depression. While the use itself is not capable of causing the disease, it certainly helps to make it more evident in those who already have a predisposition to develop it.
Environmental factors
Other risk factors that are related not only to bipolarity, but to other disorders as well, are environmental factors and traumatic experiences. In environments full of conflicts and situations that can generate trauma, emotions and thoughts easily become confused, which can assist in the development of bipolar disorder.
What are the symptoms of affective bipolar disorder?
The symptoms of bipolar disorder are concentrated in episodes of mania and depression. These episodes not only affect the emotional, but also alter sleep patterns, energy and disposition of patients.
Episodes of Mania
In episodes of mania, the patient:
- You feel joy or intense energy, you feel “in the clouds”, capable of anything;
- He has a lot of energy and willingness to carry out various activities;
- Performs more activities than normal, sometimes even more than he can handle;
- He has trouble sleeping – he sleeps little and feels very electric, without the need to rest;
- He speaks quickly and with intensity, changes the subject very quickly and easily;
- Demonstrates agitation, irritation or sensitivity to what others say or do – may be aggressive;
- Feel your thoughts racing through your mind;
- He believes he is capable of doing many things at once;
- It shows impulsiveness and lack of judgment;
- Engages in risky activities such as risky sex, spending money compulsively, among others;
- You may have psychotic symptoms, think that you are someone important as a politician, or believe that you have super powers.
Episodes of Depression
During low periods, in episodes of depression, the patient:
- Sit down, sad, empty and hopeless;
- He does not have much energy and disposition for daily activities;
- Finds trouble sleeping – can sleep more or less than recommended;
- He feels that he cannot appreciate anything, loses interest in activities that used to give him pleasure;
- He stops attending social events and loses interest in interacting with other people;
- You may have feelings of worry, guilt, feeling worthless and worthless;
- You have trouble concentrating and making decisions;
- Forget things, your memory is affected;
- Eat too much or too little;
- You feel tired or drowsy, you may feel pain in your body;
- Have thoughts about death or suicide;
- You may experience psychotic symptoms, such as believing that you have committed a crime or that you are a very bad person or a burden on others, while none of this is true.
Mixed episodes (episode specifier)
In the DSM-5 edition, when there is a mixed (that is, joint) occurrence of manic and depressive symptoms, the specifier “with mixed characteristics” is added, as the patient can present characteristic feelings of both, feeling ill, without hopes, while feeling energetic and willing to continue carrying out various activities.
Often, the bipolar themselves do not notice the changes in mood, and can feel as if everything is fine. However, friends, family and co-workers can notice changes in mood and in the way of carrying out activities. This is important because they can be the first to suspect that something is wrong with the patient, which helps in the diagnosis.
Symptoms in children and adolescents
In children and adolescents, episodes can manifest themselves in different ways.
In a manic episode, children and adolescents can:
- Feeling very happy and happy, doing nonsense and playing that they do not usually do or that other children and adolescents do not do;
- Have an explosive temper;
- Talk very fast about many things;
- Having trouble sleeping, but not feeling tired;
- Having trouble concentrating;
- Doing risky things;
- In the case of teenagers, they can talk and think about sex more often.
In depressive episodes, they can:
- Feeling sad for no reason;
- Complain of pain frequently, such as headaches or stomach pains;
- Sleep too much or too little;
- Feeling guilty or feeling like they are worthless;
- Eat too much or too little;
- Have little energy and lose interest in fun activities;
- In the case of teenagers, there may be thoughts about death and suicide.
Children can behave aggressively when their parents deny something. This behavior can last for hours. They can also show happiness by playing games that are out of their usual behavior.
Teenagers may experience problems at school such as poor grades, suspensions for fights or drug use, stop participating in extracurricular activities, get involved in risky sex, and exhibit suicidal behavior or intentions.
It is extremely important that parents are attentive to these behaviors, so that the child or adolescent is diagnosed and treated as soon as possible, avoiding worsening of the development of the disease.
Diagnosis
For a correct diagnosis, it must be done by a mental health professional (psychiatrist or psychologist), who can order tests to rule out the possibility of other diseases that may have similar symptoms, such as hyperthyroidism .
The professional can also request an overview of the person’s life, ask him to tell his story, as the types of bipolarity can be easily confused with other diseases if there is no analysis of the previous episodes.
Type I can be easily confused with schizophrenia , while type II can be diagnosed as Major Depressive Disorder, if the professional is not aware of the previous hypomanic episodes or atypical characteristics (when it is the 1st episode).
Most patients seek help when they are having a depressive episode, not when they are feeling good as they feel with mania or hypomania. Therefore, the professional must be careful not to misdiagnose the patient.
To diagnose Bipolar Affective Disorder, the professional must first check for the presence of manic and depressive episodes. The criteria for identifying these episodes are present in the Diagnostic and Statistics Manual for Mental Disorders – 5th edition (DSM-5).
Diagnosis of manic episode
You must have at least 3 of the following symptoms for at least a week:
- High self-esteem: Feeling of greatness and intense well-being with oneself;
- Decreased sleep need: Feels ready for work after only a few hours of sleep;
- Verborragia: Speak more, faster and louder than usual;
- Escape of ideas: Accelerated and uncontrollable thoughts that result in difficulty in expressing yourself clearly and quickly forgetting previous ideas and issues;
- Easily distracted: Attention constantly diverted to external stimuli, resulting in many concurrent and incomplete jobs;
- Restlessness: Generates an increase in the number of activities done at work or school;
- Impulsivity: Lack of self-control, impatience and anxiety;
- Risk behaviors: Take more risks than usual, such as driving dangerously, consuming alcohol excessively, using illicit drugs, not using condoms, spending savings.
Diagnosis of hypomanic episode
Hypomania is classified when there are at least three symptoms of mania, however:
- The change in mood and functioning must be different from the characteristic and sufficient to be noticeable by other people;
- It is not serious enough to cause considerable difficulty at work, at school or in social activities or relationships;
- It does not require hospitalization or cause loss of contact with reality;
- The symptoms are not caused by drugs, toxins or any other medical condition.
Diagnosis of a depressive episode
To diagnose a depressive episode, there must be at least 5 of the symptoms below for 2 weeks or more, including depressed state or anhedonia:
- Depressed state: feeling depressed most of the time or sad;
- Anhedonia: decreased interest or loss of pleasure to perform routine activities;
- Feeling of uselessness ;
- Excessive guilt ;
- Difficulty concentrating: often decreased ability to think and concentrate;
- Fatigue: excessive tiredness, lack of energy;
- Sleep disorders: insomnia or hypersomnia almost daily;
- Psychomotor disorder: Cognitive and motor agitation or slowness;
- Eating disorder: Loss or significant weight gain, in the absence of diet;
- Suicidal ideation: Recurring ideas of death or suicide.
In the case of dysthymia, the presence of 3 to 4 symptoms is necessary for at least 2 consecutive years. For the diagnosis of bipolar, this phase cannot have been caused by grief , drugs or other illness.
Comorbidities
There are several diseases that can appear together with bipolar disorder, including some that can overlap the symptoms and hinder the treatment of the disorder. Therefore, it is important that these comorbidities are treated as well.
Some of these diseases are generalized anxiety disorder, attention deficit hyperactivity disorder and substance abuse (chemical dependency).
In addition, bipolar people are at greater risk of developing some physical illnesses, such as thyroid problems, migraines , cardiovascular diseases, diabetes , obesity , among others.
Is Bipolar Disorder Cure?
To date, a cure for Bipolar Affective Disorder is not known. However, the disease can be controlled through appropriate treatment, as well as several mental disorders.
What is the treatment?
Because it is a disease caused by biopsychosocial factors, treatment is usually done through medication and psychotherapy. It is extremely important that the patient is also inserted in a healthy environment, with people who support him and try to help in his improvement.
Treatment in adults is the same as in children and adolescents, but parents or guardians must be attentive and, in case of side effects, notify the responsible doctor.
Know the main treatment measures:
Electroconvulsive therapy (ECT)
Used in extreme cases, electroconvulsive therapy is one of the most effective treatments in episodes of very severe mania or depression. It assists in the prevention of exhaustion, in patients with mania, or of suicide in depressive patients.
Rarely used, this type of therapy can serve as a last resort when the drugs have no effect, or when there are too many side effects. It is also used in pregnant patients, as several of the medications can affect the development of the fetus.
Electroconvulsive therapy consists of passing high voltage electrical current over the temporal region, which causes a seizure that lasts a few seconds, while the patient is anesthetized.
This technique is used because it is effective in balancing some neurotransmitters directly linked to the disorder, such as serotonin , dopamine, norepinephrine and glutamate.
In general, they are done between 2 and 3 sessions per week until the patient is better. The sessions are held while the patient is sedated by rapid general anesthesia, and lasts between 5 and 10 minutes. The patient does not feel any discomfort or pain and is discharged on the same day.
This technique, which seems outdated and cruel, can be very effective and safe if applied correctly. In case the patient has doubts, it is advisable to take them out directly with the professional who will apply it, as he will be able to clarify better and help to calm the patient.
Repeating Transcranial Magnetic Stimulation (EMTr)
EMRT is a technique that uses magnetic pulses to stimulate brain cells that are involved in the control and regulation of emotions and mood, and can assist in depression.
It is a safe and non-invasive technique that lasts about 6 weeks, with 5 sessions per week.
Psychotherapy
Psychotherapy is essential for the improvement and control of bipolarity, since exposure to the feelings and difficulties caused by the disease can destabilize the patient even more.
In these cases, psychotherapy helps the patient to stay strong, deal with possible relapses and also make sure the patient does not give up on treatment.
There are several types of therapies that can help, some of them are:
Cognitive behavioral therapy
This type of therapy focuses on finding unhealthy beliefs and thought patterns that harm the patient, and replacing them with positive beliefs and thoughts.
In this way, it helps the patient to understand factors that trigger episodes, as well as teaches how to better deal with stress and situations that can provoke intense emotions.
Psychoeducational guidance
The technique is aimed at the knowledge of the disease itself, in which the patient learns more about bipolar disorder and, with this, can better recognize the symptoms in himself, which can help the mental health professional to prescribe the most appropriate treatment. adequate.
The more information the family and friends have, the more it facilitates the recognition of when the patient is going through an episode, helping them to react in the best way to the situation.
Interpersonal and social rhythm therapy
From English Interpersonal and Social Rhythm Therapy , this therapy is focused on stabilizing rhythms and patterns, establishing a balanced routine for the patient. This therapy works to control sleep, meals, diets and exercises, which can help the patient to find greater stability for their emotions as well.
Other therapies
Some other therapies that can benefit not only the patient, but also family and friends, are: family therapy and marital therapy ( couple therapy ).
It is important that people close to the patient are aware of the disease, understand how it works and be treated as well, as the emotions and mood swings of bipolar individuals can also harm interpersonal relationships.
Drug treatment
Drug treatment is usually done with mood stabilizers, antidepressants, antipsychotics and, in urgent cases, tranquilizers. Medicines must be prescribed by a mental health professional and treatment should not be discontinued without the professional’s consent.
Because it is a disease that lasts a lifetime and can become invisible (hibernate) for a few months or years, there is a risk that patients who feel well and believe they are cured and therefore stop taking their medication without doctor be aware.
It is necessary for the professional to explain that bipolarity is a chronic disease and the treatment is for life, being able to undergo changes and adjustments according to the patient’s needs.
Which medications will be prescribed depends a lot on the patient’s condition. The most common is to start with mood stabilizers, to avoid oscillations. If necessary, antidepressants may be prescribed a few weeks after the mood stabilizer.
In general, it is not common for an antidepressant to be prescribed without the stabilizer, as its exclusive use could trigger an episode of mania and worsen the condition of depression. In addition to the reverse effect, the use of the stabilizer may also have an inefficient response, losing improvement in a short time.
In the short term, the effect of the remedies is only felt after 2 weeks of use, and may extend to 4 weeks if there are still no significant results. After stabilization (complete improvement) of the patient, it is necessary to adjust the treatment for the maintenance phase.
In this case, it is possible that there is a decrease in doses or even complete change of medication. It is necessary that the patient continues to take what is prescribed, because although he feels well, the disease is only controlled, not fully cured.
Before prescribing, the doctor needs to know all the medications that the patient uses regularly, even if they are not related to mental health, including over-the-counter medications, natural supplements and alternative therapies. This is because some drugs and assets can interact with others, canceling results or increasing dangerous side effects.
Medicines
The main classes of drugs commonly indicated for the treatment of BD include:
Mood stabilizers
Mood stabilizers can be easily identified as the most important remedies in the treatment of bipolar disorder, as they help control the cycling process (oscillations), avoiding manic or depressive episodes.
Some medications to be used as stabilizers are:
- Lithium carbonate ;
- Carbamazepine ;
- Oxcarbazepine ;
- Sodium Valproate ;
- Lamotrigine ;
- Gabapentin ;
- Topiramate .
It is interesting to note that, apart from lithium carbonate, mood stabilizers are also used as anticonvulsants in the treatment of epilepsy .
Antidepressants
Antidepressants are generally prescribed during depressive episodes. They must be used in conjunction with mood stabilizers, to prevent the onset of manic episodes.
Some antidepressants used are:
- Imipramine Hydrochloride ;
- Clomipramine Hydrochloride ;
- Amitriptyline Hydrochloride ;
- Nortriptyline Hydrochloride ;
- Maprotiline Hydrochloride ;
- Tranylcypromine ;
- Moclobemide ;
- Fluoxetine Hydrochloride ;
- Citalopram ;
- Paroxetine Hydrochloride ;
- Sertraline Hydrochloride ;
- Fluvoxamine ;
- Venlafaxine Hydrochloride ;
- Mirtazapine ;
- Tianeptine ;
- Reboxetine ;
- Bupropion Hydrochloride .
Antipsychotics
Antipsychotics are used because they have an anti-manic and antipsychotic effect, that is, they help control symptoms such as hallucinations and delusions.
Some antipsychotics used are:
- Haloperidol ;
- Ziprasidone ;
- Lurasidone ;
- Chlorpromazine ;
- Trifluoperazine ;
- Periciazine ;
- Thioridazine ;
- Thiotixene;
- Risperidone ;
- Clozapine ;
- Olanzapine ;
- Quetiapine hemifumarate .
Tranquilizers
Tranquilizers should only be used during crises, while mood stabilizers are not yet effective. Some examples are:
- Diazepam ;
- Clonazepam ;
- Lorazepam ;
- Bromazepam ;
- Zolpidem hemitartrate .
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
How to live together
Bipolar Affective Disorder can be difficult to deal with both for the carrier and for friends and family. Therefore, some measures must be taken to live with the disease during the most intense treatment period, as well as after the control, during maintenance.
The patient must help himself by committing himself to the treatment and taking the medications at the right time.
Remember that treatment is for life and cannot be stopped when the patient feels well or when he feels it is not working – even though it has been years since treatment started. In case the treatment has lost its effectiveness, it is necessary to inform the doctor and ask for adjustments.
Maintaining an established sleep and meal routine can help the patient to control the disease. It is also recommended that the patient abstain from the consumption of alcohol and other substances, as they directly affect the brain and may trigger a new episode.
It is also important that the patient does not self-medicate with tranquilizers, flu, antiallergic and analgesics, as the active ingredients can mix with regular medications and cause unwanted adverse effects.
When perceiving signs that a new episode of mood is starting, it is extremely important that the patient talks to his doctor, reporting his thoughts and wishes without prejudice. Only then will the doctor know what is really going on and be able to help correctly.
The patient should take advantage of the periods when he feels well to get to know himself better, discover how he normally feels sadness and joy, observe his disposition and normal behaviors, as this helps a lot when it comes to identifying a new crisis.
How can family and friends help?
It is important that family and close people know that, often, the disease speaks louder than its carrier, requiring understanding and patience during crises.
It is necessary for people to understand that the symptoms are the disease and not characteristics of the person itself, as this relieves feelings of guilt from the bipolar person.
Support for treatment is essential, especially when it comes to medication. Helping the patient to remember the times and doses of the medications to be taken contributes to not having a new crisis, since the absence of them for a few days is enough for the symptoms to return.
In periods of mania, the patient may claim that family members are accusing him and refuse the guidelines. In these phases, it is important to point out the symptoms comprehensively, without judgment, so that the patient understands what is happening.
If the patient spends a lot of money during periods of mania, one way to get around this is to talk to him while he is well and agree to take credit or debit cards from him during these episodes.
While the patient is in depressive periods, family and friends should pay attention to suicidal thoughts, especially if the patient speaks openly about it. It is important not to leave the patient alone, as well as to take objects and utensils away from him that he can use to try to take his own life.
It is also important that the family does not demand too much or protect the patient too much. The first can cause a lot of stress and trigger an episode, while the second can make the patient settle down and not try to leave the “comfort zone”, avoiding fighting the disease.
Complications
The biggest complications related to bipolar are discontinuation of treatment, substance abuse, cognitive difficulties, symptomatic worsening and thoughts of self-harm and suicide.
The patient must be constantly reminded that treatment is what makes him feel good and, if he decides to stop, the symptoms can come back suddenly.
Over the years, ineffective treatment or the patient’s neglect to maintain follow-up can make mood swings more intense and more difficult to medicate. Difficulties in memory, concentration, learning, as well as spatial orientation can be gradually reduced.
Although substance abuse can be a triggering factor of the disease, it can also be a consequence, because, to escape emotional pain, the patient can get involved with alcohol or illicit drugs. It becomes a vicious cycle, since the use worsens the disease and the disease can increase the use.
Suicide is the most frequent cause of death among young bipolar individuals. Estimates are that 50% of people with bipolar disorder attempt suicide at least once in their lives, while 15% actually commit.
During episodes of mania, the individual may engage in risky sex, which can lead to an unwanted pregnancy or contraction of sexually transmitted diseases. In addition, you can spend a lot of money compulsively, which can wipe out your family’s savings.
The delay in diagnosing and getting treatment for bipolar disorder is also a complicating factor. It is estimated that, in Brazil, it takes about 6 years for a patient to be correctly diagnosed with bipolarity.
Another complication is the fact that bipolar patients are more likely to develop chronic physical diseases, such as cardiovascular disease, obesity, among others.
Prevention
There is no way to prevent the disorder itself, only crises and episodes of mood. Some tips are:
Pay attention to symptoms
Noticing the presence of symptoms early in an episode prevents the episode from getting worse. Identifying triggering factors also helps. It is important to notify the doctor if the patient realizes that he or she is starting a new episode of mania or depression.
It is recommended to encourage family and friends to pay attention to the signs, as the carrier himself may not notice.
Avoid consumption of alcohol and other drugs
The use of substances that act directly on the brain can worsen symptoms, as well as trigger a new crisis.
Taking the prescription drugs
Keeping the doses and schedules as prescribed are the best measures for the treatment to work correctly. When he feels like stopping, the patient must be reminded of the consequences, including that the symptoms may return with full force.
Contact your doctor before taking new medications
It is important that the professional responsible for the treatment is aware of all the medications that the patient is taking, and when taking new medications, whether they are prescribed or not, notify the doctor. This is because drug interactions can be serious and trigger a new episode.
