[Inkscape.org](Inkscape.org)
<a href='https://www.freepik.com/vectors/depression'>Depression vector created by pch.vector - www.freepik.com</a> and
<blockquote class="twitter-tweet"><p lang="en" dir="ltr">My girlfriend who suffers from BPD is currently in a coma after trying to commit suicide by jumping from a 5 story balcony in Spain. We are currently fundraising for life saving treatment. Please share to to help raise awareness for mental health. Keep Tionne in your prayers 🙏🏽❤️ <a href="https://t.co/i9UgF7yuiW">pic.twitter.com/i9UgF7yuiW</a></p>— Shadia 🌹 (@shadia_rashida) <a href="https://twitter.com/shadia_rashida/status/1574415557835001857?ref_src=twsrc%5Etfw">September 26, 2022</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
In the last post, we saw some of the anatomic structures in mood and drew a close to discussing the biology of mood disorders. The structures were the prefrontal cortex, the amygdala, the Anterior Cingulate Cortex, the Hippocampus and the Amygdala.
We saw that the case of PTSD as a comorbidity in BAD was not very common but is still a not-worthy presentation as it is a type of anxiety disorder.
We took a look at treatment tips for those who ae are alcohol dependent.
[Inkscape.org](Inkscape.org)
<a href='https://www.freepik.com/vectors/depression'>Depression vector created by pch.vector - www.freepik.com</a> and
<blockquote class="twitter-tweet"><p lang="en" dir="ltr">Hank here. Mom's mental health got worse. She saw a Dr yesterday and has been diagnosed with bipolar, depression, anxiety and PTSD. I might be gone for a bit while she is adjusting to the 4 medications she was prescribed. Please pray for my momma. I love her very much. <a href="https://t.co/sap7ZebEKq">pic.twitter.com/sap7ZebEKq</a></p>— Hank The Tank (@HankThePuppy) <a href="https://twitter.com/HankThePuppy/status/1575197386757967872?ref_src=twsrc%5Etfw">September 28, 2022</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for two consecutive months. This month will be dedicated to BAD or Bipolar Affective Disorder. In the first month, we discussed Depression, and in the subsequent month, anxiety. We are done looking at a Nigerian study and now we are moving to Twitter posts.
# Announcement!!!
We are moving to our new account after this month's topic. Follow us here @medicvibes
In this post, we are looking at this tweet that talks about suicide in Bipolar Affective Disorder. If you would like to join in raising funds you can head to the tweet through the link. As you do this you will be blessed.
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.
Top Left [King Saul](https://en.wikipedia.org/wiki/Saul#/media/File:Saul_1878.jpg), Top Right [Hippocrates](https://en.wikipedia.org/wiki/Hippocrates#/media/File:Hippocrates.jpg
) Bottom Left [Robert Burton](https://en.wikipedia.org/wiki/File:Robert_Burton_by_Gilbert_Jackson.jpg
) Bottom Right [Anatomy of Melancholy](https://en.wikipedia.org/wiki/The_Anatomy_of_Melancholy#/media/File:Robert_Burton's_Anatomy_of_Melancholy,_1626,_2nd_edition.jpg
)
**History**
**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**
Among all the mood disorders BAD I has the earliest **onset**. The prevalence of BAD I is equal in men and women. Episodes of mania are seen more in men while depressive episodes occur more in women. Depression appears to have a higher occurrence in rural areas, there is a tendency for schizophrenia to be misdiagnosed by practitioners from a different culture from the patient.
**Other Associated Conditions**
People who deal with mood disorders are significantly at risk of dealing with alcohol abuse or dependence, anxiety disorders particularly panic, obsessive-compulsive and phobias, particularly for people and socialising. Women particularly have eating disorders when they go through unipolar and bipolar disorders. Biogenic amines affect the concentration and effect of the neurotransmitters at the synaptic cleft. Cholinergic agonists modulate the activities of the pathway between the hypothalamus, Pituitary gland and adrenal gland. GABA inhibits the action of monoamine pathways that ascend especially the mesocortical and mesolimbic.
**Biology of BAD**
The studies were done with Urinary Free Cortisol, 24 house intravenous taps for plasma cortisol, cortisol in saliva and a test of feedback inhibition. There are known documentation about the changes in hormone interplay in the brain and reactions that can be a result of early life stressors. Early trauma can lead to increased hypothalamic–pituitary–adrenal(HPA) activity which is followed by cerebral cortex volume depletion and cellular reduction. HPA activity is being referred to as a clear feature of mammalian stress and it is a link between depression and the biology of chronic stress. 60% of the time cortisol is not suppressed in the morning or it escapes suppression by 4 pm.
In 40% of outpatients with depression and 80% of inpatients, it is seen as easy arousal. The characteristics of this easy arousal are longer periods of nighttime awakeness, reduced sleep time, an increase in the Rapid Eye Movement (REM) phase of sleep and a rise in body temperature. Reduced secretion of growth hormone is linked with this reduced slow wave sleep. This is because there is increased REM drive and reduced fast-wave sleep that results in a reduced first period of non-Rapid Eye movement (NREM). These hyperintensities are seen more frequently in BAD I and elderly patients.
They are evidence of neurodegenerative affectation of the brain due to mood disorders. There are 4 regions in the brain that modern medicine believes are the seat of emotions - the prefrontal cortex, anterior cingulate, hippocampus, amygdala and amygdala. The ACC is believed to control emotions when stimulated especially when goals become harder to achieve because of problems. There are two divisions of the ACC - the affective and cognitive parts. The affective part is connected to the limbic region and the cognitive part to the prefrontal cortex. The cognitive part is connected to the PFC and other cortical parts of the brain.
**Genetic Factors**
There have been many families, adoption and twin studies that have outlined the fact that mood disorders might be inherited. What scientist are cracking their brain around these days is to find the specific molecules that can be attributed to this.
**Family Studies**
For today we will look at the family studies and find out what they have to tell us. A familial disorder presents in families, is it possible to find this type of occurrence in mood disorders which are different when compared to everyone else
From what we know from studies, a child that has a parent with a mood disorder has a 10 to 25% chance of developing a mood disorder. The chances will go up and reach close to double that number. A family that has more members affected has a greater chance.
There is an even greater risk if the relatives that are affected are close relatives as opposed to being distant. If a family member has BAD it put the person at higher risk of mood disorders generally speaking but specifically puts the person at risk of bipolar disorder.
The fact that there is a family predisposition may give a picture that there is a genetic background to these conditions. When there is a severe form of the condition it also gives this picture more vividly
Different models of transmission of genes have been explored to find the relationship to mood disorders. The most prominent model is the mendelian theory.
# Suicide in BAD
[Source](https://www.vecteezy.com/vector-art/3261117-mental-health-illustration-concept-vector)
According to medical data, 95% of those who attempt suicide or commit the act have an underlying mental health condition. Among those who commit the act have a mood disorder precisely depression.
Although this post didn’t state if the patient was manic or depressed at the time, for patients with BAD 15 to 20% of them are at risk of death to suicide in their lifetime and it is mostly during the depressed phase of the condition.
More patients with depressive disorders commit suicide early in the illness rather than later;
Most patients will attempt suicide earlier in the course of the condition than in the later phases and the chances are higher if they are male and single, separated, divorced or had had a loved one especially a spouse die. They are usually middle-aged or older and isolated (as was the case of covid)
Data about this is known because those who do usually do not mix with society.
Suicide is also very likely to occur following the months of discharge from the hospital. It is important to nowt that those who eventually commit suicide were more likely to not be using the medication prescribed. Among those who were on treatment, it was also found that they were not receiving an adequate dose.
# Tip
Suicide in the psychiatric population is preventable, study shows that treatment assessments for adequacy usually reveals findings.
When a patient is going through an unbearable amount of pain and suffering, it is believed that their suicide is inevitable. Such people are usually exceptions when compared to the more typical cases. Some others suffer from personality disorders and are likely to spontaneously do it when they are dysphoric and/or intoxicated.
History taking for these patients usually includes the patient’s psychiatric history, a mental state examination, and an assessment for depressive symptoms and suicidal ideations. When a patient does not have plans for the future, has been giving out their belongings, has made a will or has had a grave loss, they are at significant risk. It is important to evaluate the patient's relatives' coping strength and their social support before hospitalization.
# Hive Stories
@nulledgh0st talks about suicide in the family. It was written about a year ago and has deep hurt in it. I hope that healing reaches your family.
Read this post [here](https://ecency.com/hive-150329/@nulledgh0st/sunflowers-for-hope-starting-a-memorial-foundation-for-my-sister-focused-on-mental-health-awareness-suicide-prevention)
# Questions
- What did you learn about mood disorders?
- What did you learn about Bipolar disorder?
- What did you learn about the suicide of Bipolar disorder?
# Conclusion
In this post, We have looked at how genetics might have a part to play in mood disorders especially when structured through the mendelian pathway.
We saw that there is a significant risk of suicide in BAD patients especially when they are depressed.
There are important features to be looked at before hospitalization of suicide-prone patients and they are the psychiatric history, mental state, depressive symptoms and others.
# I hope that you learned a lot from this post.
To book me for illustration gigs click [Here](https://www.fiverr.com/share/yxYkBZ)
# References
- [Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry](https://www.amazon.com/Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry/dp/1451100477)
- Page demarcations made with [Inkscape.org](Inkscape.org)
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