Bipolar Disorder — Guy Goodwin / Serious Science

so I'd like to talk a little bit about bipolar disorder it's a psychiatric disorder a mental disorder is characterized by episodes of either depression which is obviously low mood and exhaustion and mania which is characterized by high mood and increased energy and these states alternate with each other over often a lifetime and they can be extremely difficult to manage and very difficult and destructive with patients lives so what we see when we first see someone with depression or with mania is a very clear change from their normal state and this usually happens or starts for the first time between the ages of 15 and 25 now it's not invariable that that happens but that's the commonest way in which it starts and when it starts with depression it is difficult to diagnose because depression could simply be common or garden depression not bipolar disorder you've got to have a manic episode before you can say that someone has a bipolar disorder and that sometimes takes a little while to materialize and to be manifest so when you have seen a manic episode in a person then you know that they have a pretty long haul ahead of them and you've got to think carefully about how you should propose treatment how do we recognize mania or mania presents with increased energy and reduced need for sleep tremendous enthusiasm over confidence and this can even get to the level of becoming psychotic and people become quite deluded about their powers their ability the prospects that are ahead of them and sometimes in those circumstances they make really bad decisions and those decisions can be about money they can be about their relationships they can be about taking big risks generally be they physical psychological or literally a monitor and so those risks often translate into minor disasters or quite major disasters for people so when people develop mania it's important to try and cut it short and that's often a reason why people come to a psychiatric hospital for the first time and we continue to have to use psychiatric inpatient facilities to look after people with mania what is a longer term problem for these people however is usually the depression and the depression kind of follows the mania often rather like the night follows the day and the depression is something that the patients really don't like it's extremely unpleasant people feel lacking in energy Laden they're lacking interest they lack in any kind of optimism for the future and they may very well get suicidal and feel suicidal and indeed I'm afraid that suicide is not uncommon in patients with bipolar disorder and it's usually in the first phase of their life with the disorder that he did occur so this is often happening to young people and that's in its way is often a tragedy so that is that is the kind of and the outline of the disorder what causes it well we think now that we were pretty confident that most of the causation lies in genetics but those genetic causes are filtered obviously through one's environment once growing up in a particular setting one's experiences and although we don't think that those are fundamentally important if they're very adverse then they often make the course of the illness worse so if you have a bipolar genetic risk and you also on top of that have very difficult early experiences and very often the bipolar disorder is worse so that's a kind of the cocktail that we unfortunately often see in our patients and that makes them more severely ill but though genetic causes are now increasingly understood to be not just a single gene or several genes but many genes and these genes all exercise a minor effect so the analogy that we usually use is between getting a deck of hair a deck of cards you get a hand of cards each card is maybe slightly different we have variation in our genes and our set of cards and you play that set of cards as your as it were as your life's chances and if your life chances are loaded up for bipolar disorder then that's often the way it goes and if you are an identical twin of someone with bipolar disorder the chances you get it are extremely high so we're talking about 80% if you're a a non identical twin or as brother or sister then those risks are very much lower and if you're a child of someone bipolar disorder you often find you and we're often asked this the charges that you get the illness is only about 6% so it's a genetic disorder it's not due to single genes we can't imagine treating it through eradicating the genes but we do have to think about how we treat it because for many people it's such a very difficult problem now the main way in which we treat it is that we have to look at the different phases of the illness so if you look at mania because it's such an emergency because people are often so disturbed because their behavior is so abnormal we usually have to use medications and those medications can be difficult for the patient's to accept they're usually based on the blockade of dopamine function in the brain and the drugs are sometimes called antipsychotic drugs so the classic antipsychotic drug that was invented now a long time ago was chlorpromazine and that when it was very first first invented than 1950s it was actually used on manic patients and we continue to use the the newer versions of chlorpromazine to treat the acute phase of a disorder and it's important that we do that so that it's not to look prolonged that people don't stay in hospital to - so - longer stay and that we don't get the consequences of profound and prolonged overactivity which in the past used to be in themselves quite dangerous so getting people out of their manic episodes is relatively straightforward and at least there's a formula for doing it depressive episodes are rather more difficult replicas may spontaneously get better but treating them is often quite tricky and we often have to have patience there are a number of medications available for that and we also use various forms of psychological treatment that seem to help but getting people better from depression is more difficult and depression more often becomes rather chronic so that people remain somewhat depressed after their recovery from mania or the recovery from severe depression and that's very troublesome for them and it's also easy for us to accept that outcome because it's kind of the problem lies with the patient so you have to work quite hard to make sure that people make a full recovery now what keeps people well is a range of things one is that they have to make important lifestyle choices so if they have a particularly up and down sort of world in which they're forever running themselves to the max and the one hand and then collapsing on the other certain sorts of lifestyle lend themselves to that if they're using stimulant drugs cocaine or indeed probably cannabis we think that that's a bad idea for those people and if in addition they are taking upon themselves massive risks and and pressures which are putting them under major strain so we think that those sorts of things that people have to be realistic about and so it's difficult sometimes for them to make the adjustments because they're used to kind of running their engine at full speed and that's not something probably they can continue to do in addition it's very commonly the case that patients will be recommended to take medications that stabilize the mood in other words they prevent these episodes of depression or mania and the one that the most famous of them is a drug called lithium lithium is an element as I'm sure many of you know it was it's it's present in and mind as an element but in batteries but it's most important use in man I would argue is to treat bipolar disorder and what we see when we use lithium is that there's a surprising reduction in the frequency of severe episodes and pretty good evidence that we reduce the risk of suicide this was an effect that was discovered over over 60 years ago and it's very surprising that we not really done a lot better since since that discovery the mechanism is probably through chemists brain chemistry that links to how transmitters in the brain communicate for nerve cells so we think we sort of understand the mechanism that we've not yet ever produced something that substitutes as effectively for lithium there are other medications that are used there often from originally their use in epilepsy we don't quite understand what the link between epilepsy and bipolar disorder is whether there's some sort of common pharmacology some common ground on which the pharmacology works but nevertheless they do seem to be useful and there are drugs like pardon me the motor gene and others that are used to to manage patients in the long term with bipolar disorder finally we think that it's very important for the patients to understand their illness so part of the role of the psychiatrist the doctor is to communicate to the patient the risks around their illness what shapes it what precipitates episodes and what they can do to reduce that and that's we often call psychoeducation and that's the foundation really of the relationship that the doctor must have with the patient and if you get the formula right between psychoeducation on the one hand which is essentially psychological or behavioral and medication on the other and you strive to avoid the adverse effects of the various medications that we use then you can often come up with a way for people to live pretty service securely with their illness unfortunately that's not true of everybody and for those people for whom it's not true bipolar disorder is a very major burden and even for those for whom we're successful they are often less able to earn for example in living at the they would have expected to and they have to make very major adjustments so bipolar disorder is one of these conditions which really challenges the individual it affects and it's more severe forms about almost one in a hundred people and in its milder forms it affects another one in a hundred people so it's pretty common and if we all know well about 200 people the chances are we know at least one person with bipolar disorder so it's not something that's far in another it's part of all our lives and it's something we need to know about

Channel: Serious Science

Views: 6,021

Rating: 4.9587631 out of 5

Keywords: science, lecture, Serious Science, Bipolar Disorder, Guy Goodwin, Psychiatry, psychiatric disorder, mental disorder, depression, mania, manic episode, psychiatric hospital, dopamine, antipsychotic drug, chlorpromazine, Depressive episodes, psychological treatment, chronic depression, mood, Lithium, brain chemistry, brain, lamotrigine, psychiatrist, psychoeducation, mood stabilizing drug, mood stabilizers

Id: UbK-4HWNLVk

Length: 11min 26sec (686 seconds)

Published: Tue May 05 2020