Bipolar disorder

Bipolar disorder is a biological change, with well-defined symptoms, that causes distress to both those concerned and those close to them.

Essentially, it is the result of a change in the mechanisms that regulate mood.

tulburarea bipolara

Bipolar disorder is a mental condition in which a person goes through:

  • episodes of very “low mood” – depressive episodes,
  • through episodes of increased, “high” mood – manic/hypo-manic episodes.
  • In between episodes, which is most of his or her life, the person behaves and feels normal.

With proper treatment, new episodes can be prevented and a stable balance between states can be maintained.

The limbic system area of the brain acts as a true mood ‘barometer’, similar to a thermostat. It keeps states within constant limits and activates the structures needed to maintain balance.  A person’s mood tends to be regulated by the limbic system in accordance with the environment in which they live. People suffer from bipolar disorder when they (the limbic system) are not functioning well; their mood becomes unstable, variable and independent of their environment.

Causes that can trigger bipolar disorder

Today we can say without any doubt that bipolar disorder has a biological basis and is genetically transmitted. The theories that bipolar disorder is caused by various psychological or social factors (childhood trauma, dysfunctional family relationships, personality traits, and personality traits (dual) are no longer valid. We now know that all these factors can trigger the disorder or make it worse, but they are never the cause.

A number of factors contribute to bipolar disorder, including genetic, biochemical and environmental factors.

Factors of bipolar disorder

Genetic factors

Bipolar disorder, especially bipolar I (BPI), has a major genetic component, involving ANK3, CACNA1C, and CLOCK genes.

Biochemical factors

There are several physiological mechanisms involved in bipolar disorder, most of which are at the level of neurotransmitters.

Neurophysiological factors

Increased activation in the ventral limbic system of the brain has been shown. It mediates the experience of emotions and the generation of emotional responses.

Environmental factors

In some cases, exposure to external stresses or pressures may contribute to exacerbating genetic or biochemical predispositions underlying the disorder. For example task. It is a particular stress for women with a history of bipolar disorder and increases the possibility of postpartum psychosis.

Bipolar disorder is chronic and recurrent.

That means you have it all your life, even if it’s not as severe at all stages of your life.

Epidemiological data

Nearly 4% of the population suffers from bipolar disorder. Although many people believe otherwise, the truth is that bipolar disorder has existed throughout history. That means it is as old as mankind. The prevalence of this disorder is similar in all countries. This shows that it is a universal disorder, unrelated to cultural or social context.

The age of onset of bipolar disorder varies widely. For both types, BPI and BPII, the age range is from infancy to 50 years. The average age is about 21 years. The most of the cases of bipolar disorder begin when individuals are aged 15-19. The second most common age of onset is 20-24.

Some patients diagnosed with depression (bipolar) may indeed have bipolar disorder. They continue to develop the first manic episode in their 50s. These people may have a family history of bipolar disorder.

Gender differences

BP I occurs equally in both sexes. However, bipolar disorder with rapid cycling (≥4 episodes/year) is more common in women than in men. The incidence of BP II is higher in women than in men. Most studies report nearly equal percentages between genders in the prevalence of TB I. However, most studies report an increased risk in women for BP II/hypomania, rapid cycling, and mixed episodes.

Approximately 40-50% of those who have had a manic episode will have a second one in the next 2 years. The relapse rate (recurrence of a new episode) at 4 years varies between 40 and 87%.

Fortunately, today we have very effective treatments that keep bipolar disorder in check. So many people who in the past would have had to spend much of their lives institutionalised or on the margins of society can now have a normal life. In other words, they are no longer slaves to their disorder.

Many bipolar patients have a natural social, family and emotional life

And they keep their jobs as well as the rest of the population. In fact, the list of people with bipolar disorder who have changed history is telling:

  • political leaders like Churchill
  • painters like Van Gogh
  • Gauguin or Pollock
  • brilliant composers like Schumann or Tchaikovsky
  • jazz musicians like Charles Mingus
  • writers of great depth, such as Virginia Wolf
  • Hemingway, Baudelaire
  • Herman Hesse
  • Edgar Allan Poe.

We need to start thinking and looking at bipolar disorder like any other chronic illness. Diseases such as asthma or diabetes, nothing more or more serious. This is because in for the most part, the disorder can be kept under control by proper medication and by strictly following the recommendations behavioural (bipolar).

Triggers of bipolar disorder

The causes of bipolar disorder are genetic and biological, but they can lie dormant for a long time in the absence of triggering conditions. On the other hand, the presence of triggers alone is not sufficient for the onset of an episode in the absence of vulnerability due to genetic and biological factors.

Triggers include:

stressful life events physical/physiological/psychological; accompanied by loss (death of a loved one, loss of job/house/economic/social status, divorce, etc.) or not (birth of a child, starting college, promotion in a job, etc.);

disruption of sleep – wake rhythm (due to time zone changes, shift work, night work, random work, prolonged partying, etc.);
unusual physical/physiological conditions (in pregnancy, childbirth, substance use, etc.);

psychological factors (hostility from the family environment – childhood and/or present – manifested by criticism, aggression or suffocating attachment; own thoughts, emotions, perceptions, resulting from growing up in a negative environment, etc.);

psychosocial factors (isolation, lack of social support, disruption or absence of an orderly social life, etc.).

tulburare bipolara

The importance of stabilizing factors

Since instability is the of life.


The first stabilizing factor is medicationwhich has a regulatory effect on the underlying causes of the disorder. But as triggers occur all the time in life, psychological and social measures are needed in addition to medication. Ensuring the main dysfunction in bipolar disorder, stabilizing factors become a veritable antidote. It leads to fewer relapses and a better quality presence of stabilizing factors to help the body in its attempt to maintain organised rhythms of sleep, appetite, energy and tone.

Stabilization factors psychosocial and psychological are:
  • ordering daily rhythms(sleep – wakefulness; activity – inactivity; eating; physiological functions);
  • reconciliation with oneself(going through a period of psychological mourning after significant losses; awareness and relief of negative thoughts).
  • restoringand maintaining interpersonal relationships (social support, friends, partners, etc.).
  • practicingproblem-solving skills (finding individual solutions);
  • stress management(relaxation techniques, etc.).
  •  (tehnici de relaxare etc.).

Symptoms of depression in bipolar disorder

The essential feature of the depressive episode is:

  • involves a period of at least 2 weeks
  • in which 5 (or more) of the following symptoms were present most of the day,
  • most days.
  • They must represent a change from the previous level of operation.
  • At least one of the symptoms is either (1) depressed moodor (2) loss of interest or pleasure.
  • Depressed mood

Most of the day, almost every day. This is indicated either by subjective reporting (e.g: “I feel sad or empty inside”) or comments made by others (e.g.: “looks tearful”).

Note: in children and adolescents the mood may be irritable.

  • Diminished interest or marked pleasure

Faced with all or almost all activities for most of the day, almost every day (as indicated by the patient or by the observations of others).

  • Significant weight loss

In the absence of a weight loss or weight gain regime. E.g. a change of more than 5% in body weight in one month, decrease or increase in appetite almost every day.

Note: in children, consider the absence of expected weight gain.

  • Insomnia or hypersomnia almost every day.

  • Agitation or psychomotor retardation almost every day

(also observable by others, not just the subjective feeling of restlessness or slowness).

  • Fatigue or lack of energy almost every day.

  • Feelings of worthlessness or inadequate guilt

(which can be delusional) almost every day, not just self-reproach or guilt about the condition.

  • Decreased thinking ability or concentration

Or indecision, almost every day (either through subjective accounts or accounts by others).

  • Recurring ideas of death

Not just the fear of dying, recurrent suicidal ideation without a specific plan or suicide attempt, or a specific plan to commit suicide.

Symptoms of mania and hypomania in bipolar disorder

Bipolar disorder is an alternation of depressive episodes, asymptomatic phases and episodes of euphoria. The latter are called “mania” or “hypomania”, depending on their intensity.

Mania (depressive) is a state of high mood or persistent and unnatural irritability. It is characterized by the following symptoms: self-esteem increased self-esteem, decreased need for sleep, fatigue, thinking fast thinking; the person is easily distracted, restlessness psychomotor; underestimation of risk and involvement in pleasurable activities, which can have potentially serious consequences. Not all of these symptoms need to be present. Just as there can be depression without sadness, there can also be mania in which irritability and anger completely overshadow happiness.

Symptoms of mania

However, we must recognize that one of the most common classic symptoms of manic episodes is increased self-esteem. It can mean anything from a lack of self-criticism to the idea of obvious grandiosity reaching delusional proportions.

Speech is, typically logorrheic, rapid and difficult to interrupt. The person usually speaks loudly. The things said are usually more jokes, lines and relatively funny remarks. If the mood is predominantly irritable, the discourse will be full of complaints, complaints, hostile comments.

Delusional ideas of grandeur are a common thing. (belief in the existence of a special personal relationship with God or a political or religious figure, etc.).

Psychotic symptoms

Psychotic symptoms tend to occur during manic phases. These are of two types:

hallucinations (perceptions without an object to justify them, i.e. seeing things or people, hearing voices, etc.);

are fluent in a language you have never studied, the belief that you are being followed by the KGB, etc).

There always tends to be a need for sleep. The affected person usually wakes up a few hours earlier than usual, feeling full of energy. When the sleep disorder is severe, a person may go several days without sleep and feel tired.

Irritability or inability to accept opinions and statements contrary to one’s own are not uncommon. This can lead to verbal or physical abuse against objects (breaking things) or people.

Increased thinking speed

Another classic symptom is speed of thinking which some patients have defined as “watching two or three TV channels at once”. The thoughts tend to occur faster than they can be put into words or even understood, and thinking can be completely disorganized.

Often, symptoms such as expansiveness, unreasoning optimism, grandiosity and poor judgment can lead to careless engagement in pleasurable activities such as:

  • excessive or casual sexual activity
  • speeding
  • unlimited shopping
  • unrealistic economic investments (such as hoarding a lot of unnecessary things: expensive antiques, 20 pairs of shoes, etc.).
The role of medication and psychotherapy

The key goals of bipolar disorder treatment are to reduce the number and severity of episodes of any polarity, prolonging euthymic periods and strengthening stability; and to improve quality of life.

To achieve these objectives, the following contribute pharmacotherapy as a continuous basic treatment, through its direct and relatively immediate action on the brain, but also psychosocial interventions (psychoeducation and psychotherapy). They reinforce the effects of the medication and help build skills that allow the person to live a more fulfilling life.

The role of pharmacotherapy

Medication plays a fundamental role in the treatment of bipolar disorder as it acts directly on brain stabilisation. The type of medication depends on the treatment area it is intended to cover:

  • treatment acute mania(mood stabilizers, benzodiazepines for sleep, antipsychotics for mood stabilization and remission of psychotic elements)
The role of psychological treatment

Drug treatment is the basis of interventions in bipolar disorder. However, an important change has occurred in the last 10 years when it comes to treatment recommendations in international guidelines. Psychological interventions have become an indispensable part of successful treatment for bipolar disorder. There are specific scientifically validated forms of additional treatment in addition to medication. A large number of studies over the last 10 years have shown concrete benefits in all stages of treatment for bipolar disorder.

Psychoeducation for bipolar disorder

  • It is the most recommended method of psychosocial intervention. It is applicable both individually and in group sessions of 9, 12, 21 weeks with/without family members.
  • Patients learn about bipolar disorder treatment, causes, treatment, prevention of new episodes based on early detection of signs, regularity of lifestyle.
  • The most studied (since 2003) is the method developed by psychiatry professors Dr Colom and Dr Vieta, from the University of Medicine in Barcelona, Spain, who also developed a standardised application manual, published in 2006.
Eficienta Psihoeducatiei In Tulburarea Bipolara

Psychoeducation chart


Numerous studies and meta-analyses in multiple countries have repeatedly proven the effectiveness of the method. Some of the most important results:

  • The number of recurrences decreases (23%, Colom, 2009)
  • Increases the period until the next relapse (Colom, 2009)
  • The number of hospitalizations is decreasing (Candini, 2013)
  • Decreases the number of hospital days (Candini, 2013, Colom, 2013)
  • Reduces the number of days spent in acute episode by 27% (Colom, 2009)
  • Increases adherence to treatment (Rahmani, 2016)
  • Reduces perceived stigma (Cuhadar, 2014)
  • Normalizes brain activity (increases inferior frontal gyrus activity, decreases right hippocampal activity) (Favre, 2013)
  • Increases the level of functioning (Kurdal, 2014)

Interpersonal and Social Biorhythms Therapy (IPSRT)

It is the only form of psychotherapy developed specifically for the treatment of bipolar disorder by Dr. Ellen Frank. Dr Ellen Frank is a professor at the University of Pittsburgh School of Medicine, USA. It is derived from interpersonal therapy (Klerman, Weissman) and is based on the negative effects of disorders circadian rhythm and interpersonal relationships on mood (social zeitgeber).

It is a medium-length (3-6 months), individual therapy with a focus on self-monitoring mood and lifestyle regulation, as well as on solving interpersonal relationship problems. Disease history is linked to personal issues to find episode triggers specific to each patient.

Complete a mood diary

A weekly table tracking mood variation, sleep schedule, social time, physical activity and social events. Based on this, correlations are established between interpersonal aspects (disputes/role transitions, grief/loss, conflicts, isolation), biorhythm aspects (sleep schedule changes, over/under stimulation) and weekly mood changes.

Along with the triggering role of these events and biorhythm variations in the occurrence of past episodes , a plan to avoid a new episode is also analyzed, developed for each situation. The therapy addresses strategies to regularize the lifestyle, modify the aspects correlated above, regulate interpersonal relationships and most importantly, intensively address the acceptance of the disorder and “mourning the healthy self“.

Although international recommendations emphasize chronic medication and psychological interventions, in Romania the treatment of this common disorder is almost exclusively medication.

Recent evaluations of the comparative effectiveness of these psychological approaches (Miklowitz DJ, 2014) have established that the most successful are the care (of the patient with bipolar affective disorder) systematic and coordinated, psychoeducation (Colom, Vieta), interpersonal and social biorhythms therapy (Ellen Frank 2005), cognitive-behavioral therapy and family therapy.

Recent meta-analyses (Colom, Vieta, 2007) show a more than 40% reduction in relapse rates for patients with bipolar disorder who add psychoeducation interventions and training in early detection and management of depressive and manic/hypo-manic episodes to their medication treatment.

Program pentru tulburarea bipolara 


The medication treatment of bipolar disorder is chronic. Ongoing adjustment and monitoring are required. The patient-psychiatrist relationship is a very important one, that’s why our doctors are at your disposal for questions, concerns and we are open to your proposals.


Our psychotherapists are available for individual therapy (weekly sessions) or family therapy. In our clinic, therapists combine psychotherapy with elements of interpersonal and social biorhythm therapy, created specifically for the psychological management of bipolar disorder.



– – Unique service in Romania –

Our 12-week program combines psychoeducation following the model developed by Colom and Vieta, with Ellen Frank’s interpersonal and social biorhythms therapy, in a unique psychological intervention in Romania, aimed at restoring balance.


1. It is the most effective course

The effectiveness of this course is repeatedly proven by international studies (Colom,Vieta; 2003,2005, 2010, 2015)

2. It applies the latest international standards

It is the only program in Romania that applies the latest recommendations of international guidelines (2016) related to the treatment of bipolar disorder

3. Find out exactly what the situation is

The opportunity to find out what bipolar disorder is and what symptoms episodes have

4. Learn how to prevent

Find out what are the predictors and triggers of episodes of illness and how to prevent them, avoiding imbalances and maintaining quality of life

5. Family with you

As a patient, you and your family learn how to live with this chronic condition without stigma or guilt

6. Appropriate treatment

You have a clear understanding of the role and mechanism of action of pills and can work better with your psychiatrist to arrive at the most appropriate treatment plan for you.

7. You get a new lifestyle

You learn about the role of a balanced lifestyle and build your own “social biorhythm” (sleep, physical activity, work, social encounters and interpersonal relationships) that maintains emotional stability.

8. Significantly reduce episodes of illness

MOST IMPORTANT – A reduction of more than 40% in the rate of recurrence of new episodes of illness for those who combine the course with drug treatment.



Is it difficult for you to manage emotional problems?

Call for specialized help. Make an appointment in our clinic in Bucharest, Cluj or Iasi

Is it difficult for you to manage emotional problems?

Call for specialized help. Make an appointment in our clinic in Bucharest, Cluj or Iasi