Euthymia in bipolar disorder: characteristics and tips

The etymology of the word euthymy, eu "good and timia "courage" indicates that euthymia means good spirits.

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

Next We will see what the euthymia period of subjects with bipolar disorders consists of., making it known that these patients are not always in altered moods.

Mention will also be made of what we understand by euthymia in this disorder, as well as, in what state is the patient when he is euthymic and what changes, improvements or treatments are recommended to achieve a 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 Association of American Psychiatrists (DSM 5). This disorder is divided into two types depending on whether or not a manic episode appears.

In order to diagnose type 1 bipolar disorder, 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 type 2 bipolar disorder, 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, together 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. That is, the degree of affectation in type 2 is less, a fact that will influence 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 chronicity, but these individuals do not present a continuous alteration in mood, but show periods with states of greater stability affective.

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Characteristics of the euthymia period in bipolar disorder

As mentioned in the introduction, euthymia means good mood, without disturbances. 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. In other words, the quality of life may continue to be altered, although to a lesser degree than during episodes.

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

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

Thus, given the different characteristics that subjects with bipolar disorder present in the period of euthymia, recommends that, to assess the state of euthymia of each patient, the subjectivity perceived by each subject of the her status. That is to say, assess euthymia not by comparing it with that of other people but in the subject itself, equating 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 world of work, being able to carry out with normality of your work, it will be considered that you have returned to the state of euthymia if you can return to that job as you 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.

Several variables can influence the quality of life of the patient. 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 diagnosis, which has been shown to take 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 other will also affect mental disorder, presenting a history of suicide attempts, as well as unchangeable 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 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 for a correct sensation of well-being not only objective variables related to factors influence more difficult to modify, as it would be to achieve the complete disappearance of the symptoms, but they will also affect the perception subjective that the subject has of his state, that is, it will be important to assess how the patient feels and what concept he has 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 the lack of achievement of personal goals is modulated by the variables of self-esteem and self-efficacy of the patient.

Similarly, it is common for them to show 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 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 his disorder, greater or lesser alterations will develop on the emotional, behavioral and cognitive level. It has also been seen that it is vital to control the discomfort that the patient shows, because it has been proven that distress is related to the appearance of depression and anxiety.

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How to properly manage emotions in euthymia?

To achieve a good quality of life and an adequate state of euthymia, the subjective feeling that the patient has of his state and how he perceives himself 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 thinks of him.Thus, if it is necessary to restructure these ideas or encourage him to make exhibitions in social situations and in this way, to be able to disconfirm his negative beliefs.

In case he did not present enough social skills, it would be advisable to train the subject beforehand, in order to subsequently improve his performance in society. All 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 proper monitoring of the medication regimen, that is, the patient takes the drug as indicated by the psychiatrist. Bipolar disorder, everything and benefit from psychological treatment, needs constant medication in any phase of the disease, both during the episodes and in the remission period, when the subject is euthymic.

For all these strategies to work, one of the techniques that has obtained the best results is the psychoeducation; It allows the patient to know the disorder they suffer and understand the great importance of following both the pharmacological and psychological treatment in a way adequate, thus trying to alter his life as little as possible, keeping the subject functional and integrated into society, especially during the interval euthymic.