People Who Experience 4 Seasons in a Day…

Stating that bipolar disorder is a condition that can usually be easily diagnosed with a clinical examination, Psychiatrist Prof. Dr. Tarhan stated that these individuals can experience 4 seasons in a day. Tarhan said, “In individuals who experience manic episodes at a young age, a type of dementia called frontal dementia can develop in old age. In this case, memory is generally preserved, but behavioral changes and personality changes may occur.”

Prof. Dr. Nevzat Tarhan: “Relapse of the disease is less common in intelligent individuals and those who successfully apply stress management. As age progresses, symptoms of the disease may alleviate in some individuals.”
 

Üsküdar University Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan, evaluated the topic of Bipolar disorder.

Bipolar Mood Disorder

Prof. Dr. Nevzat Tarhan noted that Bipolar disorder is defined in Turkish as two-ended disorder or two-ended mood disorder, adding, “It falls into the category of mood disorders. Psychiatric disorders are divided into two main groups; thought disorders and mood disorders. Bipolar disorder is also the state of fluctuating between two extremes in emotions. The person alternates between manic and depressive episodes, meaning their mood and emotional state vary. Interestingly, this condition was first defined in Turkey, and Kayseri Gevher Nesibe Hospital played an important role in its establishment. Lithium was detected in the waters of the thermal springs located there. Lithium is the main medication used in the treatment of bipolar disorder and is considered the gold standard. This medication was discovered there, and the hospital was developed based on this finding. This information has also entered the literature,” he said.

Lithium is Produced Today

Prof. Dr. Tarhan stated that lithium is produced today, “However, since it was found naturally at that time, people would go to that region to drink the healing waters. When these waters were investigated, the light metal salts they contained, especially lithium, were detected. Today, lithium is used in high proportions in batteries, but this naturally occurring salt can be used for therapeutic purposes in low doses,” he explained.

Prof. Dr. Tarhan stated that this medication plays a very important role in preventing the relapse of the disease, adding, “It may not be sufficient in the acute phase, but its use in the prophylactic phase is very effective. Of course, this medication should be used under medical supervision. Because, like all medications, when used correctly, it controls and cures the disease, but when used incorrectly, it can cause harm,” he said.

Bipolar Disorder Affects 5 Percent of Society

“After depression, the most common disease group in the world is bipolar disorder. Bipolar disorder is seen in 5 percent of the population,” said Prof. Dr. Tarhan, also providing the following information:

“This means that in a city of one hundred thousand people, an average of five thousand individuals are expected to be diagnosed with bipolar disorder. If bipolar disorder is considered a spectrum disorder, there are also mild and low-severity subtypes. So, 5 percent is quite a high figure. Depression, on the other hand, is generally observed in 17 percent of a society. Major depression is a common illness. Bipolar disorder is seen in 5 percent, while schizophrenia is seen in 0.8 percent (eight per thousand). In bipolar disorder, subthreshold bipolar cases also exist. For example, a person may show emotional changes as if experiencing four seasons in a day. In the morning, while loving their child, in the afternoon they might say, ‘God damn you, why did I give birth to you?’ If this situation becomes continuous and turns into a temperament, it is called cyclothymic temperament, and these individuals may be prone to bipolar disorder.”

Causes Emotional Fluctuations

Prof. Dr. Tarhan stated that in bipolar disorder, an individual, normally quite well, experiences emotional fluctuations during certain periods of life, adding, “If these fluctuations last for more than four or more than seven days, different diagnoses may be made. In adolescents, even if the duration of these fluctuations is 24 hours, a diagnosis can be made,” he said.

Emotions Soar During Manic Episodes

Prof. Dr. Tarhan noted that bipolar disorder shows periodic changes, having two main poles: the manic phase and the depressive phase, explaining, “During the manic phase, emotions elevate, energy increases, and the individual may become overly excited. In this period, speech quantity increases, the person gravitates towards excessively pleasurable activities, engaging in behaviors like shopping and spending money. Due to increased energy, the person is constantly active, needs less sleep, and may make large, risky decisions. During manic episodes, thought flow accelerates, transitions from topic to topic occur, and attention is distracted. The person's self-esteem increases, and behaviors such as excessive interest, attachment, or falling in love may be observed. Furthermore, it may be possible for the person to exhibit behaviors that do not conform to their moral norms and could lead to regret. After the manic phase, the person's functionality decreases; problems such as being late for work or reduced productivity may occur. This period can sometimes also be associated with substance use.”

Problems in Relationships and Work Can Occur During Hypomanic Episodes

Prof. Dr. Tarhan stated that in the hypomanic phase, which is a milder form of the manic phase, the person's speech also increases, sleep need decreases, but there is no detachment from reality, and the effects are generally at a milder level, adding, “During a hypomanic phase, the individual generally maintains their daily functions, but problems in relationships and at work may occur,” he said.

Affected by Seasonal Changes!

Prof. Dr. Tarhan noted that bipolar disorder can be affected by seasonal changes and exhibit various cycles, providing the information: “Bipolar disorder can change seasonally in some individuals. Symptoms may become more pronounced in seasons like spring and autumn. In some individuals, rapid-cycling bipolar disorder may be observed; in this case, the person experiences manic and depressive episodes several times a year, even seven or eight times. During a manic episode, the person can be overly energetic, euphoric, and engage in risky behaviors. During these periods, ‘anger mania’ can also be seen; here, the person may be angry, irritable, and quarrelsome, but in this period, the emotional elevation is towards anger, not joy. In situations called mixed mania, the person gets angry, shouts, and generally exhibits a negative mood.”

A Downward Spiral is Experienced During Depression

Prof. Dr. Tarhan also noted that during depressive episodes, individuals generally experience a decline, stagnation, and lack of joy, stating, “The ability to enjoy life diminishes, interest and desire disappear. Sleep patterns may change during depressive episodes; sleep may increase in some individuals and decrease in others. Appetite changes, excessive activity, or extreme withdrawal may be observed. Decreased energy, fatigue, feelings of guilt, and worthlessness become prominent. Difficulty concentrating may occur, and suicidal thoughts may increase. The person may question their purpose in life, and thoughts of death may come to the forefront,” he said.

Diagnosis Can Be Easily Made with Clinical Examination

Prof. Dr. Tarhan stated that bipolar disorder is a condition that can generally be easily diagnosed with a clinical examination, adding, “However, it is important to determine its subtypes for an accurate treatment plan. Diagnosis is made based on clinical symptoms and subtypes. Recently, there have been developments in brain imaging techniques, but traditional methods like MRI may not always provide sufficient information,” he said.

Frontal Dementia Can Develop in Old Age

Prof. Dr. Tarhan provided information, stating, “In individuals who experience manic episodes at a young age, a type of dementia called frontal dementia can develop in old age. In this case, memory is generally preserved, but behavioral changes and personality changes may occur.” He added, “These individuals may tend to marry someone younger than themselves or exhibit inappropriate behavior in public. Sexual behaviors may increase. Like taking off their clothes, their pants in a crowd…”

Genetic Predisposition Exists

Prof. Dr. Tarhan stated that bipolar disorder shows a genetic predisposition but is not 100 percent hereditary, adding, “If one parent has bipolar disorder, the child's likelihood of experiencing this condition increases 4-8 fold. If both parents have bipolar disorder, this likelihood can exceed 50 percent. Genes related to serotonin and dopamine enzyme activities (5-HTT and COMT) are used to determine genetic predisposition. Deviations in these genes are important for assessing genetic risks and guiding the treatment process. We can currently research and examine these two genes. If there are deviations in those genes compared to normal, we maintain a stricter treatment regimen. There is a genetic predisposition to the disease,” he said. 

Psychological Resilience and Social Support

Prof. Dr. Tarhan noted that psychological resilience and social support are critically important in preventive treatment and prevention strategies for diseases like bipolar disorder, and that adopting a holistic approach, considering individuals' psychological and social needs as much as medical treatment, is essential.

Relapse Less Common in Intelligent Individuals and Those Who Manage Stress…

Prof. Dr. Tarhan stated that patients with bipolar disorder are generally kept under follow-up for two to five years, adding, “If no relapse occurs during the treatment process, the medication can be discontinued. It does not require lifelong use. Relapse of the disease is less common in intelligent individuals and those who successfully apply stress management. As age progresses, symptoms of the disease may alleviate in some individuals.”