Narrated-Bipolar Disorder

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Bipolar Disorder:

Bipolar Disorder

Bipolar Disorder Defined According to the DSM-IV-TR:

Bipolar Disorder Defined According to the DSM-IV-TR Bipolar Disorder is a recurrent mood disorder featuring one or more episodes of mania or mixed episodes of mania and depression. Bipolar Disorder differs from Major Depression in that there is a history of manic or hypomanic (milder and not psychotic) episodes.

Bipolar Disorder:

Bipolar Disorder There are basically four different kinds of mood episodes that occur in Bipolar Disorder: Mania Hypomania Depression Mixed Episodes


Mania Mania is a mood disturbance ranging from pure euphoria or elation to an irritable labile admixture that also includes dysphoria (unpleasant mood).

DSM-IV-TR Manic Episode:

DSM-IV-TR Manic Episode A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). 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:

DSM-IV-TR Manic Episode:

DSM-IV-TR Manic Episode 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep (e.g. feels rested after only 3 hrs of sleep) 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractibility (e.g. attention too easily drawn to unimportant or irrelevant external stimuli) 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. Excessive involvement in pleasurable activities that have a high potential for painful consequences

Manic Episode:

Manic Episode 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.


Hypomania Hypomania is the subsyndromal counterpart of mania. An episode of hypomania is never psychotic nor are hypomanic episodes associated with marked impairments in judgments or performance . In fact, some people with bipolar disorder long for the productive energy and heightened creativity of the hypomanic phase.

Mixed Episodes:

Mixed Episodes Mixed states can be described as the coexistence of depressive and manic symptoms. Mixed states can be expressed on a continuum ranging from psychotic features to milder and subclinical states. Frequently, the entire episode presents with severe depression with agitated features and acceleration of thought suggestive of a depressive mixed state.

Bipolar II Disorder:

Bipolar II Disorder Presence (or history) of one or more Major Depressive Episodes Presence (or history) of at least one Hypomanic Episode There has never been a Manic Episode The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Cyclothymic Disorder:

Cyclothymic Disorder For at least 2 yrs, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note : In children and adolescents, the duration must be at least 1 year.


Epidemiology Bipolar Disorder I affects 1-1.5 % of the general population of the United States Affects equal numbers of males and females Bipolar II has been identified as affecting 0.5-0.6% of the population with females affected more than males Overall economic cost in the US is estimated at $45 Billion per year Males have more Manic episodes, are likely to have a comorbidity of substance abuse/dependence Initial episodes of Mania : Males display more hyperactivity, grandiosity and risky behavior Females more often display racing thoughts and distractibility

Neurochemical Factors:

Neurochemical Factors Depression :imbalance of the neurotransmitters norepinephrine and serotonin Mania : less understood. It is suggested that symptoms result from an inability to modulate neuronal excitation It is postulated that the drug Lithium acts on the second messenger system inhibiting neurons to release, activate or respond to neurotransmitters It is also suggested that Depakote increases GABA thereby dampening aberrant neuronal excitation

Pharmacologic Treatment Modalities:

Pharmacologic Treatment Modalities Mood Stabilizers Antidepressants Antipsychotics Benzodiazepines


ECT Electroconvulsive (ECT) is an effective and often lifesaving treatment for mania or depression if pharmacologic interventions fail or if symptom severity requires immediate relief. ECT : continues to be criticized by some but remains a safe and effective treatment with minimal side effects. ECT : Patients are anesthetized for the procedure. The treatment is preformed in a closely monitored medical setting by a psychiatrist who is certified in ECT. The patient will typically receive 6-10 treatments over a period of a few weeks. The treatments are bilateral or unilateral. Most Common Side Effects include: headaches, nausea & vomiting, mild confusion and temporary memory loss, which usually returns after the course of treatment.

Psychosocial & Behavioral Interventions:

Psychosocial & Behavioral Interventions The Most Important consideration in an acute or community setting is SAFETY. Safety is best addressed in the context of patient, family and milieu management. Patients and Families need to be assisted in the design of a crisis intervention plan and family focused psychoeducation.