The etymology of the word euthymia, eu “good and timia “cheer up” tells us that eutimia means good cheer.
In the case of patients with bipolar disorder, the period of euthymia will be the one between episodes, whether manic, hypomanic or depressive.
Next We will see what the period of euthymia that subjects with bipolar disorders have consists of.making it known that these patients are not always in altered states of mind.
Mention will also be made of what we understand by euthymia in this disorder, as well as what state the patient is in when he or she is euthymic and what changes, improvements or treatments are recommended to achieve better euthymia.
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What is euthymia in bipolar disorder?
Bipolar disorder is a mood disorder cited in the Diagnostic Manual of the American Psychiatric Association (DSM 5). This disorder is divided into two types depending on whether or not a manic episode appears.
In order to diagnose bipolar disorder type 1, it will be essential that the patient suffers a manic episode characterized by the presence of an elevated or expansive mood and increased activity or energy during the period of one week.
On the contrary, for the diagnosis of bipolar disorder type 2, the presence of a hypomanic episode in which symptoms similar to those of the manic episode appear, but in this case the necessary duration will be 4 consecutive daysalong with the appearance of a depressive episode for a minimum period of 2 weeks.
It should be noted that in type 2 bipolar patients there is not as much social and work deterioration, they do not require hospitalization nor do they present psychotic symptoms compared to type 1. In other words, the degree of affectation in type 2 is lower, a fact that will influence in the characteristics of the euthymic period.
As we have already pointed out, euthymia is understood in bipolar patients. the time interval of emotional stability that occurs between episodes. With the study of the course of the disorder, it has been observed that it tends to be chronic, but these individuals do not present a continuous alteration in mood, but instead show periods with states of greater affective stability.
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Characteristics of the period of euthymia in bipolar disorder
As mentioned in the introduction, euthymia means a good state of mind, without alterations. Even so, In bipolar disorders, in the time interval where the patient does not present episodes of emotional dysregulation, the mood will not be totally normal. That is, quality of life may continue to be altered, although to a lesser extent than during the episodes.
In the case of people with bipolar disorder, euthymia does not mean completely returning to normal. It has been observed that after a post-episode mood deregulation occurs, the patient enters a state of convalescence and a need for recovery; Therefore, as expected, the subject will not present a normal state, still showing residual symptoms. This post-episode recovery interval is variable and the state of euthymia will not appear until the end of this episode..
Likewise, in the interval between episodes there will not be a completely normal mood, since as emotional dysregulation has occurred in the patient, they will show a greater degree of sensitivity to different emotional stimuli. In other words, in the period of euthymia of bipolar subjects there will not be complete emotional stability, presenting hypersensitivity to different emotional situations that will make the new appearance of an episode more likely.
Thus, given the different characteristics that subjects with bipolar disorder present in the period of euthymia, it is recommended that, to assess the state of euthymia of each patient, the subjectivity perceived by each subject of their state be taken into account. That is to say, assess euthymia not by comparing it with that of other people but in the subject himselfequating the current emotional state with the one presented before the start of the last episode.
For example, if before suffering the last episode the patient was integrated into the work force, being able to carry out his job normally, he will be considered to have returned to the state of euthymia if he can return to that job as he did before.
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Quality of life in euthymic bipolar patients
It has been proven in various studies that the quality of life of subjects with bipolar disorder is altered both during the episodes and in the period of euthymia.
Various variables can influence the patient’s quality of life. Variables such as the chronicity of the disorder, that is, the tendency to present more than one episode, as well as the time it takes to make the diagnosiswhich has been seen to require up to 8-10 years from the first symptom, are factors that can affect the presence of a good quality of life in the subject.
They will also affect variables such as: presence of cognitive deficits, comorbidity with physical illness or another mental disorder, having a history of suicide attempts, as well as unmodifiable variables such as age.
Regarding factors with a greater possibility of being treated and modified, it has been seen that it affects the loss or difficulty of establishing new social relationships, the objective decrease in autonomy and the feeling of loss of this, and the perception of bipolar disorder as a stigma, which makes the patient feel different and more isolated from society.
Therefore, it has been seen that a correct feeling of well-being is not only influenced by objective variables related to factors that are more difficult to modify, such as achieving the complete disappearance of symptoms, but they will also affect the subject’s subjective perception of their state, that is, it will be important to assess how the patient feels and what concept they have of the disease.
The aforementioned tendency is shown, for people with a diagnosis of bipolarity to present self-stigma, understanding the disorder as something bad and unacceptable. This perceived stigma on oneself can interfere with the achievement of personal goals, thus producing a worse sense of quality of life. The relationship between self-stigma and failure to achieve personal goals is modulated by the patient’s self-esteem and self-efficacy variables.
Likewise, it is common for them to show the idea that the people around them also have a stigma about bipolar disorder and about them, thus generating, in most cases, social isolation, and making reintegration into society difficult even in the period of euthymia.
Another factor that has been seen to influence the sensations that occur in the euthymic state is distress, or perceived discomfort.. Depending on the degree of distress that the patient presents regarding their disorder, greater or lesser alterations will develop at the emotional, behavioral and cognitive level. It has also been seen that it is vital to control the discomfort shown by the patient, because it has been proven that distress is related to the appearance of depression and anxiety.
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How to correctly manage emotions in euthymia?
To achieve a good quality of life and an adequate state of euthymia, the patient’s subjective sensation of their condition and how they perceive themselves will be important. Therefore, it will be convenient to work with the variables that we can modify, which will mostly be psychosocial, in order to improve the individual’s condition, especially between episodes.
It will be very important to know how he perceives himself and what vision society believes he has of him.in order to, if necessary, restructure these ideas or encourage them to make presentations in social situations and in this way, be able to disconfirm their negative beliefs.
If the subject does not have sufficient social skills, it would be advisable to previously train the subject, in order to subsequently improve his or her performance in society. All of these techniques could help improve his vision of himself and, above all, avoid isolation, a factor that greatly impairs the quality of life in the period of euthymia.
Another variable that also influences a good state of euthymia is adequate monitoring of the medication regimen., that is, the patient takes the drug as indicated by the psychiatrist. Bipolar disorder, while benefiting from psychological treatment, requires constant medication at any phase of the disease, both during the episodes and in the period of remission, when the subject is euthymic.
For all these strategies to work, one of the techniques that has obtained the best results is psychoeducation; It allows the patient to know the disorder they suffer from and understand the great importance of following both the pharmacological and psychological treatment appropriately, thus trying to ensure that their life is altered as little as possible, keeping the subject functional and integrated into society, especially during the euthymic interval.