BIPOLAR DISORDER

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OUTLINE

Intro/History

Symptomatology and diagnosis

Etiopathogenesis

Course

Treatment

NICE

Individual more recent evidence

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BIPOLAR DISORDER

Common illness affecting 2% of the world population (5% if one includes spectrum disorders)

Lifetime prevalence – 1%

6th leading cause of medical disability in the developed nations

Bipolar I – equal in males and females

Bipolar II – more in females

HISTORY – TERMS FOR MRCPSYCH

SYMPTOM DIMENSIONS IN

MOOD/PSYCHOSIS

CLASSIFICATION OF MOOD DISORDERS

Bipolar I

Bipolar II

Cyclothymia

Unipolar single episode

Dysthymia

Unipolar recurrent ‘Unipolar’

‘Bipolar’

SYMPTOMATOLOGY - MANIA

Persistently elevated, expansive, or irritable mood, lasting at least 1 week

Three (or more) of the following symptoms (4/9 in ICD)

inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

Pressure of speech

flight of ideas or subjective experience that thoughts are racing

distractibility

increase in goal-directed activity or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful

consequences

SYMPTOMATOLOGY – HYPOMANIC EPISODE

Same symptomatology as mania

Duration – 4 days

Change noticeable by others

No significant socio-occupational disturbance

No Hospitalisation

No psychotic symptoms

SYMPTOMATOLOGY – MIXED EPISODE

The criteria are met both for a manic episode and for a major depressive episode

(except for duration) nearly every day during at least a 1-week period.

Socio - occupational deterioration

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).

Copyright © 2009 Blackwell Publishing Ltd. Published by Munksgaard International Publishers Ltd. 2

Medicating mood with maintenance in mind: bipolar depression pharmacotherapy. Malhi, Gin; Adams, Danielle; Berk, Michael Bipolar Disorders. 11 Sup 2:55-76, June 2009. DOI: 10.1111/j.1399-5618.2009.00711.x

SYMPTOMATOLOGY - DEPRESSION

ALGORITHM FOR DIAGNOSIS

SUMMARY OF DSM-IV-TR

CLASSIFICATION OF BIPOLAR DISORDERS

* Symptoms do not meet criteria for manic and depressive episodes.

Bipolar features

that do not meet

criteria for any

specific bipolar

disorders

At least 2 years of

numerous periods

of hypomanic and

depressive

symptoms*

One or more

major depressive

episodes

accompanied

by at least one

hypomanic

episode

FEMALE>MALE

One or more

manic or mixed

episodes, usually

accompanied by

major depressive

episodes

MALE=FEMALE

Bipolar Disorder

Not Otherwise

Specified Cyclothymic Bipolar II Bipolar I

First, ed. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Rev.

Washington, DC: American Psychiatric Association; 2000:345-428.