Basically it is a disease that alternates episodes of mania with others of depression. In manic episodes, the patient feels euphoric, is highly active, loses the need for sleep, becomes hypersociable, sometimes promiscuous, and spends excessively. His thinking becomes accelerated and he often jumps from one idea to another without finishing developing it (it is what we call ideofugitive thinking). Delusions of grandeur can sometimes appear and the patient sometimes faces projects that are totally out of step with his reality.</ P>

The manic phase of bipolar disorder is one of the few mental disorders in which the person does not suffer from their symptoms and cannot understand why others are trying to stop their condition, because the patient feels very good, full of energy. Critical capacity is almost nullified, no risks are foreseen and there is hardly any impulse control. Naturally, they are not usually aware of the disease and are patients who generally have to be admitted with judicial authorization.

In episodes of depression the opposite happens, since sadness, feelings of guilt, apathy, asthenia and anhedonia predominate. They often have anxiety, lose their appetite and have sleep disturbances. Suicidal thoughts are common. Self-esteem always very low. There are cognitive complaints. They lose their sexual appetite. Sometimes they may present delusions congruent with their state of mind.

In bipolar disorderses Genetic vulnerability factors are combined with environmental exposure factors, which lead to the onset of the disease, generally around adolescence, and a recurrent course in which the episodes become less and less dependent on environmental triggers. Current theories about the causes of bipolar disorder are grouped into a biopsychosocial vulnerability-stress model. Genetic factors are fundamental but they explain only part of the risk of developing the disease, being important environmental factors of a biological type (brain injuries, drugs, drugs, hormonal changes), psychological (stressful events, social support) and even meteorological (changes seasonal).

Genetic studies have shown that heredity plays a major role, not only in the etiology of the disorder, but also in its clinical expression and course. On the other hand, among the biological factors involved in the origin of bipolar disorder, there are various neurotransmitters, hormones, and alterations in the clinical pattern of sleep. In addition, the so-called “life events” (life events or circumstances in which a person is subjected to significant stress) appear to be involved in the appearance of the disease in genetically vulnerable subjects, and may influence the triggering of successive relapses. Finally, it should be added that up to 20% of bipolar patients present a seasonal pattern of relapses, which consists of a peak in admissions for depression in spring and autumn, while the manic phases seem to be mainly concentrated in summer, seeming likely, for so much so that luminosity is the most relevant variable in this sense. The identification of a seasonal pattern is clearly relevant at the level of prognosis and treatment, since in times of risk medical visits and doses of prophylactic treatment may increase.

Bipolar disorder needs to be treated long-term. The treatment of bipolar disorder lies in calming or stabilizing drugs in both phases (lithium carbonate salts and valproic acid, among others). In the depressive phase, antidepressant drugs are also managed, while in the manic phase, neuroleptic drugs.

In our clinic, we treat this disorder in an interdisciplinary way, adding to the pharmacological treatment personalized psychotherapeutic interventions, essential when it comes to preventing the so frequent relapses. The treatment is, therefore, psychosocial, with a marked psychoeducational orientation, both for patients and family members, with the aim of:

• Improve medication compliance, removing obstacles that interfere with medication adherence.
• Facilitate the early identification of relapse symptoms, teaching them methods to record the occurrence, severity and course of manic and depressive symptoms that allow early intervention if these worsen.
• Cope with the psychosocial consequences of previous episodes and prevent future ones, teaching them adequate coping skills.
• Provide patients with strategies to cope with stressful social and interpersonal situations that may be triggers or exacerbators of symptom manifestations.
• Provide patients with non-pharmacological strategies to cope with behavioral and cognitive symptoms of mania and depression.

In short, we try to provide patients and relatives with skills in managing the disease, providing them with information about the disorder, its maintenance and the frequent difficulties associated with it.