Bipolar Disorder

(Manic-Depression

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Definition

-  Mood disorder characterised by fluctuations predominated by depression w periods of mania or hypomania

-  Mania: > 1 week S/S, severe functional impairment, hospitalisation likely

-  Hypomania: 3-7 days S/S, functional impairment not severe, typically no psychotic features

 

Features

-  Typically S/S free between episodes

-  Frequency varies

-  Weeks to many years of respite

-  Time between episodes reduces over time

-  90% pts w mania will have recurrance

-  May suffer sinlge episode

-  Onset > 50 yrs rare, mean age late 20s

 

Associated S/S

-  Mania or Hypomania

-  DIG FAST

-  Distracabilty

-  Indescretion

-  Grandiosity

-  Flight of ideas

-  Activity increase

-  Sleep (less needed)

-  Talkativeness

-  Rapid onset (days) lasting weeks to months

-  Episodes of several days may occurr

-  May be preceded by depression

-  May be precipitated by antidepressants

-  Infectious euphoric mood, usually happy

-  Inflated sense of self, grandiosity

-  Easily irritable or aggressive

-  Reduced need for sleep, hyperactive, energetic

-  Speech

-  Rapid, loud & pressured w humour

-  Flight of ideas if severe

-  Sometimes incomprehensible

-  Social impact

-  Spending excessively, reckless driving, unwise business decisions, sexual disinhibition

-  Hallucinations & Delusions (psychosis)

-  Indicates severe

-  Special powers, hearing God..

-  Resolve once mood restored to normal

-  Seen in Mania not Hypomania

-  Natural Hx lasts 3 months +/-

 

Classification

-  Bipolar I

-  Mania + Major Depression

-  Or Mania only

-  Bipolar II

-  Hypomania + Major Depression

-  Cyclothymic Disorder

-  Hypomania + minor depression

-  Does not meet criteria for Major Depression

 

Mx

-  Acute Mania & Hypomania

-  Acute behavioural management

-  Exclude organic condition: drug induced..

-  Hospitalisation (possibly involuntarily)

-  Valproate &/or atypical antipsychotic (Queitapine, Respiradone, Olanzapine)

-  Lithium: effective but slow onset & risk of toxicity

-  ECT in very severe cases

-  Mild S/S: Valproate or Lithium alone +/- admission

-  Long Term Prophylaxis

-  2 episodes in 2 yrs --> maintainance Rx

-  Lithium, Carbamezapine or Valproate

-  Prevent mania/hypomania & depression in 80% pts

-  Bipolar I: Lithium

-  Bipolar II: Valproate

-  Cyclothymic Disorder: +/- mood stabilizer

-  Often combined w Olanzapine (atypical antipsychotic)

-  Depression

-  Antidepressants

-  Carefule choice: prev response, interactions..

-  May induce switch to mania esp TCAs

-  Antipsychotics

-  Olanzapine & Quetiapine (atypical) less likely to produce mania

-  Lithium, ECT

-  Psychotherpay: CBT, family therapy..

-  Education: pt, family, partner..

-  GP support, self-help groups