BIPOLAR DISORDER-DEMYSTIFYING

Dr Milan BalakrishnanBombay Hospital

Mystery of Bipolar• Syndrome • Causes• Co-morbidities• Inadequate information• Casual use of the term• Misconceptions

Bipolar disorder awareness• Objectives:

• Increase awareness of bipolar disorder (including both mania and depression)

• Promote early detection and accurate diagnosis• Reduce Stigma• Minimize the Impact on those who live with this medical illness.

Bipolar Disorder-Major Public Health Issue

• 60 million suffer from BPD with about 9 million in India

• DALYS 141.7 /100000• 1 in 3 get diagnosed

• 1 in 3 people with bipolar disorder fail to comply with treatment

• Non-adherence to treatment often results in hospitalization and suicide

Prevalence Rates and Course• Bipolar I

• Lifetime: 1 in 100• = in men and women

• Ave. age onset = 20-25• Recurrent

What is Bipolar Disorder?Bipolar disorder is a serious mental illness that is characterized by extreme mood swings from mania to depression.

Mania is an abnormally elevated mood, while depression is an abnormally low mood.

Severe mania Hypomania

Mild depressionSevere depression

Moods Alternate Between “Poles”

High

Lows

Normal Mood

Biological Approach

The biological approach to bipolar disorder suggests that high or low levels of neurotransmitters such as dopamine, serotonin, or norepinephrine is the cause.

Case 1: • 35 years old male brought forcefully by family. Since a week had not slept, and had been busy writing a novel, getting banners published and building huge projects. His children were afraid of his aggressive behavior and he had recently started using recreational drugs too. He was usually flirting and acting inappropriately with women. He was fired from his job but he said that he didn’t need it as he was going to launch his own company soon.

Case 2:

• 23 year old female presented with crying spells, no interest in activities, disturbed sleep, decreased appetite, social withdrawal and a suicidal attempt of over-dosing of sleeping pills.

• Her mother often suffered from the same symptoms and was diagnosed with bipolar disorder.

Famous people with bipolar disorder.

Beethoven Musician.

Abraham LincolnU.S President

Catherine Zeta JonesHollywood Actress

• Winston Churchill-• British Prime Minister.

• Isaac Newton-• Scientist

• Vincent Van Gogh-• Artist

Mania Persistent

abnormally elevated irritable mood

> one week

Symptoms of Mania

Inflated self-esteem/grandiosity Decreased need for sleep Racing thoughts or "flight of ideas" Spending sprees Increased physical/mental energy Irritability/aggressive behavior Impulsive/risk taking Increased sexual drive

Depression• Feeling down

• Loss of interest in enjoyable things

• > 2 weeks

Symptoms of Depression (Cont.)

Weight loss/gain Insomnia/hypersomnia Psychomotor agitation/slow down Fatigue/loss of energy Decreased ability to concentrate/make decisions Recurrent thoughts of death/suicide

Hypomania

Mixed state

Between Mania and Depression

Etiological Factors• Hereditary Factors• Biochemical Hypothesis• Stressful Life Events• Family environment • Cognitive Styles as Vulnerabilities

Triggers

Stressful life events

Stimulating internal/external environment

Excessive

Caffeine/

nicotine

Alcohol/ drug

use

Seasonal change

Changes in

routine

Stressful relationships

B.D. comorbidities & Differential Diagnosis

• Bipolar vs. unipolar• ADHD• Schizophrenia• Substance abuse

Prognosis

1. Suicidality2. Presence of a personality disorder3. Quality of family and social support4. Substance use5. History of severity of prior episodes6. Bipolar I type is most severe7. Treatment onset-the sooner the better8. Age of onset-the younger the more severe

Management

• Seek Help

• Early detection of Individual ‘signature’ signs.

• Ensure the safety of patient and others~• Suicidal behavior• Homicidal behavior• Risk taking behavior ( financial, sexual, driving etc.)• Exhaustion

The Warning Signs of Suicide

Talking about death, self-harm, or suicide Feeling hopeless/helpless/worthless Withdraw from friends/family Acting recklessly Putting affairs in order or saying goodbye Seeking out weapons or pills

Recognize Warning Signs

Offer Support/Help/Listen

Take It Seriously/Get Them Help

How to Help Someone Who is Suicidal

Treatment• Medication- Mood stabilizers.

• Electroconvulsive therapy in acute mania or depression

• Psychoeducation for patient and family

• Psychological therapy (Interpersonal and social rhythm therapy, CBT & others)

Monitoring and prevention

• Continually monitor psychiatric status

• Identify individual’s triggers

• Identify early warnings and seek help

• Prevent relapse and encourage adherence to treatment.

Help for care givers

• Burnout• Take care of own health- seek professional help for own problems

• Family, couples therapy, Group therapy

• Join a Support group.

Self-Help For Bipolar Disorder

Monitor your moods Make healthy choices Seek support Keep stress in check Get educated

Dr Milan Balakrishnan

Mindcares ClinicMumbai

+91 9930160068

dr.milanb@gmail.com