Bipolar DIsorder Diagnosed when a person experiences symptoms of depression at sometimes and symptoms of mania at others. Mania: Elevated or irritable mood lasting at ;east 1 week accompanied by three or more of the following symptoms: Grandiosity Distractibility Decreased sleep More goal-directed activity or psychomotor agitation Belief that there is pressure to keep talking Subjective expression of racing thought Excessive involvement in pleasurable activities, that have high potential for painful consequences.
Bipolar I Disorder Most often Starts with depression 75% of the time in women 67% of the time in men Recurring disorder Can affect very young people as well as older people
Bipolar I Disorder:Prognosis Prognosis is poor compared to major depressive disorder 40% to 50% of people with B1D may have a 2nd manic disorder within 2 years of the first one. Related to: Premorbid poor occupational status Alcohol dependence Psychotic features Depressive features Male gender
Bipolar II Disorder Not widely studied Preliminary data indicates a stable diagnosis No change in 5 years Chronic condition that warrants long-term treatment strategies.
Treatment B1D Prophylactic treatment with lithium Improves course and prognosis of disorder Only 50% to 60% achieve significant control with lithium. Treatment of depressive symptoms with antidepressants. See Depression and Suicide ppt. Antidepressants table 15.1-36 page 558 Kaplan & Sadock
Treatment Pharmacological treatment is divided into acute and maintenance phases Involves formulation of different strategies Treatment of mania, hypomania or depression
Treatment: Acute Mania Lithium Carbonate Prototype mood stabilizer Action can be slow In early phases of treatment, usually supplemented with atypical antipsychotics, mood stabilizing anticonvulsants or high potency benzodiazepines. Therapeupic levels of lithium 0.6 to q.2 mEq/L Valproate Only indicated for acute mania Typical doses: 750 to 2500 mg per day