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In the last post, we started the third series of posts for our mental health series. In that post, we started talking about Bipolar Affective Disorder with a post about a study done in Enugu Nigeria. We discussed broadly Bipolar Affective Disorder and we introduced the study. We talked about Mood disorders in history and the bible.

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Welcome to Medic Vibes, a place where we discuss and make sense of mental health disorders. My name is Dr Ebingo Kigigha, and I am a medical doctor (aspiring psychiatrist) and creative individual (illustration and music). We have been doing this for two months in a row. This month will be dedicated to Bipolar Affective Disorder, or BAD for short. The first month we discussed Depression, and the following month we discussed anxiety. As we did two months ago, we will begin with a discussion of a study. So far we have introduced the study and talked about previous studies done to outline the peculiarities of Bipolar Affective Disorder.

In this post, we will be continuing with the talk about the study. This study was done in Enugu Nigeria. Enugu is a state in Easter Nigeria with a population of about 820 thousand people. Today we will be discussing the people involved in the study and the procedure that was used to make this study possible.

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Bipolar disorders

Patients who are bipolar have these major depressive episodes and manic episodes. Mood disorders are also called affective disorders 2 months ago, we talked about depression, among the types of depression is Major Depressive Disorder which is otherwise known as unipolar depression.

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History

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Top Left King Saul, Top Right Hippocrates Bottom Left Robert Burton Bottom Right Anatomy of Melancholy

King Saul's features in the bible, were typical of mood disorders when he would have David play for him in his palace. Hippocrates believed depression was a result of black bile and he called it Melancholic (meaning Black Bile). The first person to describe depression in English text was done by Robert Burton. His book Anatomy of Melancholy dates back as far back as 1621. Emil Kraepelin developed the criteria that is still used for manic-depressive psychosis. It was called folie circularie.

Demographics
Mood disorders are quite common as found in a study. Major Depressive Disorder was ranked as the most common with a prevalence over a lifetime of 17%.

While that of BAD is less than 1% but its exact estimation is difficult because of missed cases.

The prevalence of the major affective disorder is higher in women. The statistics show that in virtually every culture and every country it is double the value you find in men.

When we discussed depression I tried to separate the causes that were defining for women on their own. These were related to the menstrual cycle and childbirth. According to some authors, there is the belief that women also have learned helplessness and there are different factors that cause stress in men and women.

The prevalence of BAD I is equal in men and women. Episodes of mania are seen more in men while depressive episodes are seen more in women. Women who have more manic episodes than men usually have both presentations of depression and mania. There is a higher rate of rapid cycling where there are many manic episodes in a year, 4 and over.

Among all the mood disorders BAD I has the earliest onset. A patient can start showing symptoms as early as the age of 5 to about 5o years. The mean age of occurrence for BAD I is 40 years. New studies show that Major Depression can start earlier than 20 years. The thought is that it is due to the early use of illicit drugs and alcohol.

When examining the relationship between mood disorders and marital status it was found that Major Depressive Disorder, was more common in unmarried. Bipolar I was also seen more in the unmarried but this was thought to be a result of the issues the condition can have with marriage.

Socioeconomic status was not found to be directly related to Major Depressive Disorder but for BAD I, it was found to occur more in higher income classes. There is also a higher incidence among those who are ungraduated from university but this may be a result of the early incidence of the condition.

Depression appears to have a higher occurrence in rural areas, there is also a tendency for schizophrenia to be misdiagnosed by practitioners from a different culture from the patient.

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Subjects and Method

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This study was done in a Federal Neuropsychiatry Hospital in Enugu that was established when Nigeria gained independence around 1960.

The hospital used to be a private hospital in the 70s but in the 80s it was moved into a secondary school. The hospital used to be state funded till 1996.

The number of resident doctors has increased from 2 to over 20 over the years and so has the population of other staff such as nurses and consultants.

The Hospital functions closely with the Department of Psychological Medicine at the University of Nigeria.

The population of this hospital in a census done was about 17 million people in the whole southeast and other states of Nigeria that the hospital caters to.

The study was a cross-sectional study meaning it captured participants like a snap shot, similar to the previous study.

In other for participants to be included in the study, they had to:
a. Had to have received a diagnosis of BAD or mania.
b. They have to be a patient of the hospital.
c. They need to be able to give permission orally.

Some patients were not included in the study because they didn't give permission or their mental state was in question at the time and couldn't be involved.

The study made use of questionnaires to gather data about the epidemiology and specific diagnostic features. A Neuropsychiatric Interview was done on each patient. This was done to confirm the diagnosis of BAD I or II. Those who did not meet the Diagnostic and Statistical Manual criteria were not included in the study.

The study population comprised 2 groups one from the hospital earlier described and the other from a private hospital. Those from the federal hospital were 49 while those from the private hospital were 45.

The two groups were identical in sex and age but the mood and illness at the initial phase of the BAD were different.

The analysis method was with Statistical Package for Social sciences version 11.5.

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Tips

The goals of mood disorder treatment include ensuring patient safety, ensuring proper diagnosis, and A scheme that takes account of this diagnosis and the treatment plan.

The treatment still follows the biopsychosocial route. This emphasises the use of psychotherapy and drugs but attention is given to the social aspect that could bring stress and relapse.

A satisfied patient means a satisfied doctor. Treatment for the mania and depressive phases exist and are effective. So is the one for prophylactic management.

It is important to note that episodes have a good prognosis. However, the overall condition may not show major improvement and may need restrategising.

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Hive Stories

@inber explains that she was dealing with BAD for some time. With hospital admissions for about a month and trying to cope with medications, it can be very difficult. Here is a link to the post, let's try and show some love and support.

Questions

What did you learn about mood disorders?
What did you learn about Bipolar disorder?
What's the most interesting aspect of this study?

Conclusion

Bipolar affective disorder does not have a sexual predilection. TypeI is more common in younger people even from the age of 5. The study was a cross-sectional study. Treatment of episodes are more effective than treating the whole condition.