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”.
Don’t Forget to Solve all the previous Year Question asked on BIPOLAR DISORDERS
