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


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Bipolar (Pathways)

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Inflammatory Arthritis