Euthymia in bipolar disorder: characteristics and tips for managing it.

These are the characteristics of euthymia and its implications for quality of life.

The etymology of the word euthymia, eu "good" and thymia "mood", indicates that euthymia means good mood.

In the case of patients with bipolar disorder, the period of euthymia will be the period between episodes, whether manic, hypomanic or depressive.

In the following we will see what the euthymia period consists of. we will see what the euthymia period of bipolar patients consists of.It will be explained that these patients are not always in altered mood states.

We will also mention what we understand by euthymia in this disorder, as well as in what state the patient is in when he/she is euthymic and what changes, improvements or treatments are recommended to achieve a better euthymia.

What is euthymia in bipolar disorder?

The 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 is essential that the patient suffers from a manic episode characterized by the presence of an elevated or expansive mood and increased activity or energy during a one-week period. during a period of one week.

On the contrary, for the diagnosis of bipolar disorder type 2 it will be necessary 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 days.The patient may also have a depressive episode for a minimum period of 2 weeks.

It should be noted that in type 2 bipolar patients there is less social and occupational impairment, they do not require hospitalization and do not present psychotic symptoms compared to type 1. In other words, the degree of affectation in type 2 is less, a fact that will influence the characteristics of the euthymic period.

As we have already noted, euthymia in bipolar patients is understood to mean the time interval of emotional stability that occurs between episodes of euthymia.. With the study of the course of the disorder it has been observed that this tends to chronicity, but these individuals do not present a continuous alteration in mood, but show periods with states of greater affective stability.

Characteristics of the euthymia period in bipolar disorder

As mentioned in the introduction, euthymia means good, unaltered mood. However, in bipolar disorders, in the time interval where the in bipolar disorders, in the time interval where the patient does not present episodes of emotional dysregulation, the mood will not be completely normal.. That is to say, the quality of life may still be altered, although to a lesser degree than during the episodes.

In the case of people with bipolar disorder, euthymia does not mean a complete return to normality. It has been observed that after post-episode mood dysregulation occurs, the patient enters a state of convalescence and 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 the episode..

Similarly, in the interval between episodes there will not be a completely normal state of mind, since the patient will show a greater degree of sensitivity to different emotional stimuli as a result of emotional dysregulation. In other words, in the period of euthymia in bipolar subjects there will not be complete mood stability, presenting hypersensitization to different emotional situations, which will make the situations that will make a new onset of an episode more likely.

Thus, given the different characteristics of bipolar patients in the euthymic period, it is recommended that, in order to assess the euthymic state of each patient, the subjectivity perceived by each subject of his or her state should be taken into account. That is, to assess euthymia not by comparing it with that of other people but in the subject himself/herselfThe current emotional state should be compared with the one presented before the onset of the last episode.

For example, if before suffering the last episode the patient was integrated into the world of work, being able to perform his job normally, it will be considered that he has returned to the state of euthymia if he can return to that job as he did before.

Quality of life in euthymic bipolar patients.

It has been proven in several studies that the quality of life of subjects with bipolar disorder is altered both during episodes and in the euthymic period.

Several variables can influence the patient's quality of life. Variables such as the chronicity of the disorder, i.e. 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.

Variables such as: presence of cognitive deficits, comorbidity with physical illness or another mental disorder, history of suicide attempts, as well as unmodifiable variables such as age, will also affect the subject.

Regarding factors with a greater possibility of being treated and modified, it has been seen that they affect the loss or difficulty in 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 sense 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 also by the subjective perception of the subject's state, i.e., it will be important to assess how the patient feels and what concept he/she has of the disease.

The aforementioned tendency for people diagnosed with bipolar disorder to present self-stigma, understanding the disorder as something bad and unacceptable, is shown. This self-perceived stigma may interfere with the achievement of personal goals, thus producing a poorer 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.

Similarly, it is common for them to have the idea that the people around them also have a stigma of bipolar disorder and of them, thus generating, on most occasions, social isolation, and making it difficult to reintegrate into society even in the euthymic period.

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 in relation to his or her disorder, greater or lesser alterations will develop at the emotional, behavioral and cognitive levels. 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 onset of depression and anxiety.

How to make a correct management of emotions in euthymia?

In order to achieve a good quality of life and an adequate state of euthymia, the patient's subjective sensation of his or her state and how he or she perceives himself or herself will be important. Therefore, it will be convenient to work with the variables that we can modify, most of which will 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 he believes society has of him, so that, if necessary, we can restructure the individual's condition.In this way, if it is necessary to restructure these ideas or to encourage him to make exposures in social situations and in this way, to be able to disconfirm his negative beliefs.

In case the subject does not present sufficient social skills, it would be advisable to train him/her beforehand, in order to improve his/her performance in society. All these techniques could help to improve his vision of himself and above all to avoid isolation, a factor that greatly impairs the quality of life in the euthymic period.

Another variable that also influences a good state of euthymia is the adequate follow-up of the medication regimen, i.e. that the patient takes the drug as prescribed.that is to say, that the patient takes the drug as prescribed by the psychiatrist. Bipolar disorder, while benefiting from psychological treatment, requires constant medication at any stage 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 he/she is suffering from and to understand the great importance of following both the pharmacological and psychological treatment in an adequate manner, thus trying to alter his/her life as little as possible, keeping the subject functional and integrated in society, especially during the euthymic interval.