Keywords: Mood swings, Bipolar Disorder, high expressed emotion, cyclothymia, mania, depression, quality of life, Nigeria.

Introduction.

Mood Swings among Nigerians. What are the causes of mood swing? Do Nigerians suffer from Bipolar disorder (BD)? Can children suffer from BD?  Can these conditions be treated? Celebrities suffering from BD.

It is a common slang among Nigerians to say that someone is suffering from mood swings. But what causes the mood swings are not fully understood by the generality of the people.

Mood swings among Nigerians.

Mood swings occurs when there are sudden changes in the person’s emotional state. The person suddenly switches mood from being happy to being sad or irritable or even angry and vise versa. And this mood fluctuation is not under the control of the person.

Certain mental health conditions are associated with mood swings. These mental health conditions include generalized anxiety disorder, depressive disorders, BD and borderline personality disorder. Others include substance abuse, Premenstrual Syndrome (PMS), menopause and other life changing situations like changing jobs, etc.

About 90% of persons with mental illness have 10 times risk of suffering from mood swings than the general population. And those who have mood swings have 2 times the risk of dying by suicide than those without mood swings.

Other risk factors for having mood swings among Nigerians include being a female, family history of mental illness and being bullied. Having increased use of the media and high expressed emotions, etc. are also risk factors. High expressed emotion is the emotions demonstrated by family members towards the member suffering from mental illness.

Some of these conditions that can cause mood swings among Nigerians have been written in earlier articles. In this article, BD will be elaborated. Other conditions including high expressed emotion will be written in future posts.

Do Nigerians suffer from Bipolar Disorder (BD)?

Bipolar Disorder (BD) is a serious mental health condition that causes extreme fluctuation in mood, energy and ability to function. It comes with two poles of mood fluctuation. One pole consists of sad, depressed or irritable mood, while the other pole has excessive happiness or euphoric mood.  So these people experience times of great excitements with over activity and times of sadness and hopelessness.

1. How many Nigerians suffer from BD?

Between 0.1% and 1.8% of Africans, including Nigerians in the general population suffer from BD. A study in 2 psychiatric hospitals in the southeastern part of Nigeria in 2010, reported that 68.1% of their patients had BD.

Bipolar Disorder occurs in both genders equally. And 65% of adults suffering from BD start having the symptoms before 18 years of age. So this means that children can have BD.

2. Causes and risk factors of BD.

a. Genetic:

Bipolar Disorder is an inherited disorder from one or both parents.

b. Neurotransmitter issues:

There are problems with neurotransmitters such as dopamine, norepinephrine, serotonin, GABA, glutamate, etc. These chemical are either too much or not enough.

c. Structural problems in the brain:

Certain parts of the brain have anatomical problems. These include the frontal lobe and the temporal lobes of the brain.   If the problem is on the left side of the brain, the person will present with depression. And when on the right side, the person presents with mania.

These structural problems at the frontal lobe present with cognitive issues such as memory, verbal fluency and attention issues.

d. Hormonal issues:

The hormonal issues include those from the thyroid hormones, steroids, etc.

e. Life events:

These include childhood abuse such as child sexual abuse. Sexual abuse predisposes the person to the worst outcome of BD.

f. Substance abuse:

The abuse of substances such as cannabis, cocaine, methamphetamine, alcohol, etc. can predispose to BD.

3. Types of BD.

There are three types of BD. These include the BDI, BDII and Cyclothymia.

a. BDI:

This is a severe form of BD and the person’s function is seriously affected. This presents as mania that lasts for at least one week. It may present before or after the depressive episode. And may or may not have psychotic episodes.

At the euphoric mood pole, known as mania, the person has excessive happiness or feels on top of the world. For some people the mood maybe irritable. The thoughts are racing and too many things are presenting in the person’s head at the same time. He/she has excessive interests that he may start too many projects at one time and never finishing any. Such a person can take unnecessary sexual risks by having unprotected sexual intercourse with many people. And he/she spends a lot on unnecessary things.

The energy is usually very high that the person believes that there is no need for sleep or even eating. When he eats, he is always in a hurry, and he can stay awake all night working. There is pressured speech, so that the person talks excessively and even makes unnecessary jokes. He may or may not have delusions and hallucinations. When he does, he could believe that he has abilities others do not have, or he did not previously have.  For example, he may believe that he is a prophet who can predict the future happening or he is Jesus. He can also say that he sees or hears the voice of God.

At the depression pole, the person feels sad, have loss of energy and loss of interest in things once enjoyed. There could also be irritable mood. The person also has problems with sleep. She may find it difficult to sleep or maintain the sleep, but there could be excessive sleep. There is also loss or increase in appetite. The person may also have delusions and hallucinations. So there may have guilt, worthlessness and suicidal thoughts. She may hear voices saying detrimental things about her.

b. BDII:

This is a less severe form of BD that does not seriously affect the person’s function. The moods of depression and hypomania alternate with each other. The hypomania symptoms presents for about 4 days. The difference between mania and hypomania is the gravity of the symptoms.

 The periods of happiness and excitement is enjoyed by the person. Even though the person has all the symptoms of mania, they are at a lower severity. The symptoms of depression in BDII are similar to those of BDI.   

c. Cyclothymia:

This is a type of BD that is more common in children, but can occur in early adulthood as well. It typically starts before the age of 10 years. And for children it can last for one year and 2 years in adults. The person may function normally or a little below normal.

The symptom presentations include hypomania and depression which is not as severe as the depression of BDI and BDII. And in between the highs and the low moods, the person may or may not have normal moods.

Can children suffer from BD?

Yes, children can suffer from BD. In as much that it is more in the teens, but children as young as 5 years old can present with BD.

Children with BD do present with mania and depressive phase. The mania presentations in children can present as elation and euphoria as it does in adults. But most often it comes with irritability, aggression or tantrums. They may also present with hyperactivity, that may look like Attention Deficit Hyperactivity Disorder (ADHD). One way to differentiate is that the symptoms of ADHD are long lasting, while that of BD waxes and wanes. These children may also hallucinate in BD.

The depressive presentation may present as those of the adults, especially in adolescents. But for the younger children they may complain of aches and pains, stomach aches.

In general, these children have severe mood swings, are hyperactive, impulsive, aggressive and take high sexual risks. They may become sexually promiscuous and more likely to abuse substances. The older children and the teenagers are more at risk of being suicidal.

Complications of BD.

The complications that may arise from the mental illness of BD can be physical, psychological, cognitive, social and economic.

Physical complications include heart diseases, arthritis, asthma and obesity.

Psychological complications include poor quality of life. Quality of life is how an individual rates himself or herself in life. That means how one perceives self in the context of in culture, life goals, expectations, etc. Many of those with BD abuse substances. There is high risk of the persons dying from suicide.

Cognitively, the person if in school may have academic challenges. He or she may drop out of school or be expelled.

Socially, there are challenges. These include relationship issues as well as legal issues. The person may not only end up in court, but also in jail.

There are economic issues because there maybe problems at work or problems with securing a job. Also there are financial issues that are caused by receiving treatment. In Nigeria, mental health finances are mostly out of pocket.

Treatment for BD.

It is important to recognize the symptoms of BD early in order to institute treatment. The treatment modalities include medications that include neuroleptics, antidepressants and mood stabilizers. There is need to consult a psychiatrist because the wrong applications of these medications can give very serious side effects.

The psychologist is also important here to use psychological methods. Psychotherapy is done like CBT, family therapy, psychoeducation, teaching of sleep hygiene, etc. Most often, the combination of medications and psychotherapy gives more effective results.   And one must be compliant with the treatment modalities.

Famous people that have BD and their achievements.

Bipolar Disorder is not a death sentence,  if diagnosed early and treatment instituted, the person can still achieve in life. Below is a list of some internationals and Nigerians famous people who suffer(ed) from BD.

1. On the International scene:

Ted Turner – Who founded the television channel CNN, spent most of his life living with BD. He has other accolades credited to him.

Frank Sinatra – He was a singing idol and a successful movie star. He sold over 150 million records, won academy awards, etc.

Mariah Carey – She is a top chart singer who was diagnosed with BD in 2001. She initially denied the illness, lived in isolation for years and had many professional and romantic issues. With treatment for the BD, she is able to go back into doing the things she loves most. These are writing songs and making music.

Winston Churchill – He was a Prime Minister for United Kingdom for two tenors. He published 43 books during the times he was a Prime Minister. He also won a Nobel Prize in Literature in 1953, etc.

Kanye West – He is an American rapper, a fashion designer, etc. He was diagnosed with BD and has come out openly to talk about it.

2. On the Nigerian scene:

Chacha Eke Faani – She is a Nollywood actress who went on the print media to reveal that she is suffering from BD in 2020.

Bassey Ikpi – She is a Nigerian American bestselling author and a mental health advocate. She said that she has been quite active despite her illness and this is because has been on her medications.

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