Bipolar disorders

Bipolar disorders.subtypes: 

1 . Bipolar I disorder2 . Bipolar II disorder3 . Cyclothymia4 . Bipolar Disorder NOS

1 . Bipolar I disorder

the most serious. Diagnosed after , at least 1 episode of mania. Patients typically experience MDE in their life course .

Etiology :studies reveal that, bipolar l disorder is

associated with ↑ bipolar l , ll & major depressive disorder in 1st degree relatives.

x-linkage .psychological stressors may precipitate

mania.Suicide rate is 10-15 %

Clinical manifestations :History & Mental state examination :

Single manic episode is sufficient for diagnostic requirements.

However, most patients have recurrent episodes of mania intermixed with depressive episodes.

recurrent episodes of mania intermixed with depressive episodes

Manic EpisodeDSM IV Criteria :

A) A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:1) inflated self-esteem or grandiosity2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)3) more talkative than usual or pressure to keep talking4) flight of ideas or subjective experience that thoughts are racing5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation7) excessive involvement in pleasurable activities that have a high potential for painful consequences

C) The symptoms do not meet criteria for a Mixed Episode

D) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism)

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I disorder.

Differential diagnosis :

Substance-induced mood disorder.Mood disorder due to general medical condition .Schizoaffective disorder .Borderline personality disorder.

Management :pharmacologica

l alleviating core symptoms.recognizing episode triggers. reducing negative expressed

emotion in relationships.recognizing prodromal symptoms

before full-blown recurrence.

 psychotherapeuticmood stabilizers.  anticonvulsants .antipsychotics .antidepressants.

ECT

Combination medication therapy is more common than monotherapy. 

Mood stabilizers :- • lithium : the most commonly used.• Valproic acid : is quite effective.

 

The use of antidepressants in bipolar disorder has been debated, with some studies reporting a worse outcome with their use triggering manic, hypomanic or mixed episodes, especially if no mood stabilizer is used. However, most mood stabilizers are of limited effectiveness in depressive episodes. Rapid cycling can be induced or made worse by antidepressants, unless there is adjunctive treatment with a mood stabilizer.

2 . Bipolar II disorder :

Similar to bipolar l but, mania is absent

Hypomania is essential diagnostic finding.

Suicide rate : 10-15 %.

Etiology :

Same as bipolar l .

Clinical manifestations :History and mental state examination :

Hpomania .Episodes of major depression.Never met criteria of mania or mixed state.Hypomania is determined by same symptom complex as mania

but less severe, cause less impairment, and usually don’t require hospitalization.

Differential diagnosis :As for bipolar l disorder .

Management :The same for bipolar l , although hypomanic

episodes don’t require aggressive treatment regimen as does mania .

Care must be taken with antidepressants because off their role in promoting more severe or frequent hypomanic episodes .

3 . Cyclothymic disorder :

Recurrent , chronic , mild form of bipolar disorder in which mood typically oscillates between hypomania and dysthymia .

Never diagnosed if the person had either a manic episode or major depressive episode .

Management :mood stabilizers.  antidepressants.Psychotherapy.

Bipolar Disorder NOS (Not Otherwise Specified):

This is a catchall category, diagnosed when the disorder does not fall within a specific subtype.

Thank you .