Bipolar
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  • 1. BIPOLAR DISORDERCHAPTER 15
  • 2. 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.
  • 3. 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
  • 4. 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
  • 5. 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.
  • 6. 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
  • 7. Treatment Pharmacological treatment is divided into acute and maintenance phases Involves formulation of different strategies  Treatment of mania, hypomania or depression
  • 8. 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