Bipolar Disorder
Mood episodes of mania, hypomania and depression
Mania
1) A period of abnormally and persistently elevated, expansive or irritable mood and energy lasting at least one week
2) Three or more
Inflated self-esteem
Decreased need for sleep
More talkative or pressure
Flight of ideas
Distractilbility
Increase in goal-oriented activity
Excessive activities that have a high potential for painful consequences
3) Mood disturbance is severe
4) No attributable to other causes
Hypomania
1) As above by lasting at least 4 days
2) Change in functioning that is uncharacteristic
3) Mood disturbance observed by others
4) No marked impairment in social or work function
Depression
1) 5 or more over 2 weeks
Depressed mood
Diminished pleasure
Weight loss or gain
Hypersomnia or insomnia
Psychomotor agitation
Worthlessness or guilt
Diminished ability to think
Thoughts of death
2) Symptoms cause significant distress or impairment
3) Not attributable to another cause
Presents with depression (54%), mania (22%) and mixed (24%)
Associated feature in that non-psychotic perception of senses is enhanced
Mania Episodes
25% resolved within 4 weeks
50% resolved within 7 weeks
75% resolved within 15 weeks
Hypomania
Can be elevated and euphoric but often irritability, dysphoria, depression
Self esteem up but never grandiose
Thinking is quick
Speech is loud and rapid
Risk-taking is mild to moderate
No psychosis
Episodes
25% resolve within 2 weeks
50% within 3 weeks
75% within 6 weeks
Major Depression
Bipolar I
Deprssion was present in 34% of follow up
Mania / Hypomania was present in 10%
Bipolar II
Depression in 40%
Hypomania in 5%
Mania with Mixed Episodes
Meet criteria for mania / hypomania and at least 3 for depression
Depressed mood
Diminised interest
Low energy
Psychomotor retardation
Excessive guilt
Recurrent thoughts of death
Major Depression with Mixed Features
Meet criteria for major depression plus at least 3 of
Elevated mood
Inflated self-esteem
More talkative
Flight of ideas
Increased energy
Activities with high potential for painful consequences
Decreased need for sleep
Psychosis
Delusions - False beliefs that can involve grandiosity or persecutions
Hallucinations - False sensory perceptions that are typically auditory
Disorganised thinking and behaviour
Lifetime prevalence is 60 to 75%
Medical comorbidity
Relatively common
Arthritis
Asthma
CV disease
Migraines
Thyroid disease
Suicide attempts
20%
Multiple attempts in 32%
Diagnosis
Bipolar I - One or more manic episodes
Bipolar II - One or more episodes of hypomania
Cyclothymia - Numerous periods of hypomania symptoms falling short of criteria for a hypomanic episode
Substance / medication induced Bipolar - Mood disturbance soon after substance (cocaine / phencyclidine / Corticosteroids / Stimulants)
Bipolar due to another medical condition - Hypercortisolism, MS, stroke, TBA, SLE
Other specific bipolar disorder
Mood specifiers
Rapid cycling - Four or more episodes during 12 months
Seasonal pattern - One type of episode at a specific time of year for 2 or more years
Treatment