Bipolar Disorders

BIPOLAR DISORDERS


BIPOLAR DISORDERS

  • Characterized by episodes of both mania & depression.
  • Equally prevalent in men & women.
    • Manic episodes – More common in men; depressive episodes – More common in women.
    • More commonly seen in divorced and single persons.
  • Onset age – 30 yrs (average). 
Causes:

Neurotransmitters:

  • Increased dopamine levels for manic episode.

Genetic factors:

  • Chromosomes 18q & 22q – Strongest evidence linked to bipolar disorder.
  • Chromosome 21q involved.

Subtypes:

  • Bipolar 1/2 = Schizobipolar disorder (schizoaffective disorder)
  • Bipolar I = Mania with depression (or mania alone).
    • Bipolar I 1/2 = Depression with protracted hypomania.
  • Bipolar ll = Depression with discrete hypomanic episodes.
    • Bipolar ll 1/2 = Depression superimposed on cyclothymia.
  • Bipolar lll = Depression plus induced hypomania 
    • (e.g. hypomania occurring solely in association with antidepressants or other somatic treatment.
    • Bipolar lll 1/2 = Bipolar disorder associated with substance use
  • Bipolar lV = Depression superimposed on hyperthymic temperament.

Symptoms:

Symptoms of manic episode:

  • Elevated mood – Undue happiness or irritable mood.
  • Increased self-esteem or grandiosity.
  • Decreased need for sleep (e.g. patient feels rested after 2 hours of sleep)
  • Over-talkativeness.
  • Flight of ideas.
  • Distractibility (not able to concentrate on task in hand).
  • Increased goal-directed activities (overactivity, hypersexuality overfamiliarity).
  • Psychomotor agitation.

Diagnostic criteria:

  • Symptoms should last for at least 7 days.
  • Must cause marked impairment in social & occupational functioning.

Psychotic symptoms:

  • Delusions & hallucination.
  • Maybe mood congruent (delusion of grandiosity)/incongruent (delusion of persecution).

Diagnostic criteria:

  • Must exhibit manic episode with psychotic symptoms.

Hypomania:

  • Symptoms similar to mania with lesser severity & reduced social & occupational functioning impairment.
  • Duration criterion = 4 days.

Mixed episodes:

  • Presents with both manic & depressive symptoms.
  • Duration = Min. 7 days.

TREATMENT:

  • Mood stabilizer: Lithium (prototyplcal mood stabilizer), valproate, carbamazepine, oxcarbazepine & lamotrigine (For bipolar depression).
  • Antipsychotics.
  • Benzodiazepines (lorazepam & clonazepam) – Used in acute mania due to their calming effect.
  • Antidepressants – Only as combination drug.

Exam Important

  • Chromosomes 18q & 22q have strongest evidence linked to bipolar disorder.
  • Symptoms of manic episode includes distractibility, flight of ideas & decreased need for sleep.
  • Diagnostic criteria for manic episode is that symptoms should last for at least 7 days.
  • Lithium is considered “prototypical mood stabilizer”.
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