Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes extreme shifts in mood, energy, and functioning. It is characterized by periods of unusually intense emotion and changes in sleep, energy, and behavior. These distinct periods are called "mood episodes" and include manic episodes, hypomanic episodes, and depressive episodes. Bipolar disorder can cause significant impairments and increases the risk of suicide if not properly treated. While there is no cure, treatment options like medication and therapy can help manage symptoms.

1. Mood
Disorders

2. Mood….?
A consistent emotional state experience by an
individual overtime that influences her
perception of the world.
eg;
• dysphoric
• elevated
• expansive
• euphoric

3. The Psychic Pendulum
Manic Depression

4. BPD
• Bipolar disorder, also known as manic-
depressive illness, is a multi factorial brain
disorder that causes unusual / extreme shifts
in mood, energy , activity levels, and the
ability to carry out day-to-day tasks.
• Usually symptoms are severe & lasting for
days weeks or even months.

5. D/D - Ordinary mood shifts & BPD
Unlike ordinary mood swings, Bipolar Mood
Disorder is much more intense and disruptive
to everyday function affecting energy activity
levels and judgments.

6. Signs and Symptom
• People with bipolar disorder experience periods
of unusually intense emotion, changes in sleep
patterns and activity levels, and unusual
behaviors. These distinct periods are called
“mood episodes.”
• Mood episodes are drastically different from the
moods and behaviors that are typical for the
person.
• Extreme changes in energy, activity, and sleep go
along with mood episodes.

7. Symptoms
Dramatic mood swings-from overly “high “ and
or irritable to sad and hopeless and then back
again often with the normal mood period
between.
Severe change in energy and behavior go along
with these changes in mood. The periods of
high and low are called episodes of mania and
depression.

8. Types of Bipolar I Disorder
• Bipolar I Disorder— defined by manic
episodes that last at least 7 days, or by manic
symptoms that are so severe that the person
needs immediate hospital care. Usually,
Depressive episodes occur as well, typically
lasting at least 2 weeks. Episodes of
depression with mixed features (having
depression and manic symptoms at the same
time) are also possible.

9. • Bipolar II Disorder— defined by a pattern of
depressive episodes and hypomanic episodes,
but not the full-blown manic episodes
described as above

10. MANIA
In which mood is abnormally and persistently elevated, emotionally
high, expansive or irritable especially during inappropriate
situations.
Last for at least one week .
O/E:- pt may be
• excited,
• impulsive
• euphoric,
• and full of energy.
• During manic episodes, they may also engage in behavior such as:
• spending sprees
• Un protected sex
• drug use

11. Manic symptoms
• Aggressive or Intrusive thoughts
• “I don’t have any problem’ attitude
• Fast ,incessant talk
• Increased energy & activity
• Increased perversion
• Irritability
• Poor judgment may lead to spending sprees/risky
behavior
• Tendency to e easily disturbed

12. Manic symptoms
+ at least 3 of the following symptoms:-
• Inflated self esteem or grandiosity ,
• Decreased need for sleep ,
• Pressured speech,
• Persecutory delusions
• Flight of ideas,
• Distractibility ,
• Increased involvement pleasure seeking activities with
a high potential for facing painful consequences.
some patients may have delusions and hallucinations.

13. People having a manic episode
may:
• Feel very “up,” “high,” or elated
• Have lot of energy
• Have increased activity levels
• Feel “jumpy” or “wired”
• Have trouble sleeping
• Become more active than usual
• Talk really fast about a lot of different things
• Be agitated, irritable, or “touchy”
• Feel like their thoughts are going very fast
• Think they can do a lot of things at once
• Do risky things, like spend a lot of money or have reckless sex

14. HYPOMANIA- over smart ?- optimism
• It’s similar to mania, but it’s not as severe.
• Periods of abnormally elevated ,expansive or
irritable mood lasting for 4 days.
• Never suffer from delusions or hallucination and
able to do all with their day to day life.
• Workaholic repetitive talk, low sleep, religious
mania
• Hyper Sexuality
• Often changed to full blown mania or is followed
by a major depressive episodes.

15. HYPOMANIA- over smart ?
• Increased creativity
• Poor judgment& irritability
• Increased energy & tend to become more
active than usual
• Feeling extra creatve /having innovative ideas.

16. Manic symptoms in children
• Acting very silly and feeling overly happy
• Talking fast and rapidly changing subjects
• Having trouble focusing or concentrating
• Doing risky things or experimenting with risky
behaviors
• Having a very short temper that leads quickly to
outbursts of anger
• having trouble sleeping and not feeling tired even
after sleep loss

17. symptoms of a manic episode In Teen
• being very happy
• “acting out” or misbehaving
• Taking part in risky behaviors
• Abusing substances
• Thinking about sex more than usual
• Becoming overly sexual or sexually active
• Having trouble sleeping but not showing signs of
fatigue or being tired
• Having a very short temper
• Having trouble staying focused, or being easily
distracted

18. depressive episode - @least 2wks
• Feel very sad, down, empty, or hopeless
• Have very little energy
• Have decreased activity levels
• Have trouble sleeping, they may sleep too little or too
much
• Feel like they can’t enjoy anything
• Feel worried and empty
• Have trouble concentrating
• Forget things a lot
• Eat too much or too little
• Feel tired or “slowed down”
• Think about death or suicide

19. depressive episode - @least 2wks
• During an episode of depression you may experience:
• Deep sadness
• Hopelessness
• Loss of energy / unexplained great weakness or fatigue
• Lack of interest in activities they once enjoyed
• Sleep disorder- periods of too little / too much sleep
• Anorexia/ Bulimia
• Lack of interest in sex

20. Depression
• Despaired / Suicidal thoughts
• Delusions / Hallucinations =psychotic
depression
• Guilty feeling
• Lasting for days or weeks, at least 2 weeks
• Most of the symptoms are more marked
during waking hours
• Early waking -2 hrs

21. Depression- classification
• Mild- 4 wks-30 wks
• Severe 6-m-1yr.
• Chronic –more than 2 yrs.

22. Depressive symptoms in children
• Moping around or acting very sad
• sleeping too much or too little
• Having little energy for normal activities or
showing no signs of interest in anything.
• Complaining about not feeling well, including
having frequent headaches or stomachaches etc.
• Experiencing feelings of worthlessness or guilt
• Eating too little or too much
• Thinking about death and possibly suicide.

23. symptoms of a depressive
episode In Teen
• sleeping a lot or too little
• Eating too much or too little
• Feeling very sad and showing little excitability
• withdrawing from activities and friends
• thinking about death and suicide
• Diagnosing and treating bipolar disorder can
help teens live a healthy life.

24. BPD- Symptoms in women
• Usually later in life, in her 20s or 30s
• have milder episodes of mania
• experience more Depressive episodes than Manic episodes
• Have four or more episodes of mania and depression in a
year, which is called rapid cycling
• experience other conditions at the same time,
including Thyroid, disease, obesity, GAD, and Migraines
• Women with bipolar disorder may also relapse more often.
This is believed to be caused by hormonal changes related
to menstruation, pregnancy, or menopause. If you’re a
woman and think you may have bipolar disorder, it’s
important for you to get the facts.

25. BIPOLAR DEPRESSION
Last at least 2 weeks of depressed mood or loss of
pleasure in nearly all activities +4 of the symptoms:
1. Changes in appetite or weight, sleep or psychomotor
activity
2. Decreased energy
3. Feeling of worthlessness or guilt
4. Difficulty in thinking , concentration or making
Decisions
Recurrent thoughts of death, suicidal ideation, plans or
attempts.

26. Causes of Depression
• Genetic- 40-70%
• Bad experiences during childhood
• Personality issues
• Social issues
• Loss of dears
• Somatic disorders

27. Causes of Depression
• Both environmental and genetic factors
play important roles in the disease
• Being exposed to high levels of stress
for long periods, and especially during
childhood, has been associated with the
development of BD.

28. Co morbidity with depression
• GAD
• Substance abuse
• Personality disorder

29. MIXED affective disorder
• In the context of BPD, a “mixed state” is a
condition, during which symptoms of mania
or hypomania and clinical depression occurs
simultaneously. (nearly everyday for at least
one week . Often called rapid cycling.
• The combination of high energy & low mood
makes for a particularly high risk of suicide

30. MIXED affective disorder
• Agitation
• Anxiety
• Aggressiveness
• Confusion
• Fatigue
• Impulsiveness
• Insomnia
• Irritability

31. MIXED affective disorder
• Suicidal ideation
• Panic
• Paranoia
• Persecutory delusion
• Pressured speech
• Racing thought
• Restlessness/ rage

32. CYCLOTHYMIA
• Hypomania and mild depression
• Also known as cyclothymic depression.
• A milder form of bipolar disease, consists of
cyclical mood swings. The highs and lows are
not severe enough to qualify as either mania
or major depression
• Increased risk of developing full blown
bipolar disorder

33. cyclothymia
• Numerous periods of
hypomanic symptoms as
well as depressive
symptoms lasting for at
least 2 years
• (1 year in children and
adolescents).

34. Effects of BPD
• People with bipolar disorder may have trouble
managing everyday life tasks at school or
work, or maintaining relationships. There’s no
cure, but there are many treatment options
available that can help to manage the
symptoms.
• Risk of harm to oneself or others

35. Statistics
• World wide prevalence- 5%
• Now its 4th place
• In 2020-2nd place

36. Causative factors-BPD
• Psychodynamic causes
• Genetic (40-70%)- Biological factors
• Social factors
• Abnormal brain anatomy
• Elevated glucocorticoid activity
• Postpartum hormone elevation
• Thyroid hormone dysfunctions
• Serotonin and nor epinephrine fluctuation
• Women are more likely to have depression

37. Anatomy & Biochemistry of BPD
• High Dopamine levels
• Abnormal cerebral
circuits- Amygdala,
Hypocampus &
PreFrontal Cortex
• Abnormal HPA axis
• Hypersensitivity of
Melatonin receptors in
the eye could be a
reliable indication of
BPD.

38. Prevalence
• The average age when people with BPD begin
to show symptoms is 25 yrs.
• Childhood precursors - ADHD
• Traumatic/ Abusive experiences
• Stressful events in Childhood

39. Prognosis of depression
• 30% recurrence within 10 yr
• 60% ‘’ ‘’ 20yrs.
• 15 % commit suicide 
• Substance abuse- alcohol/drugs
• CVS /THY/ COPD

40. Bad prognosis
• Slow progression
• Old age
• Lack of confident
• Alcoholics
• Personality disorder
• Lack of social support

41. If not treated properly may lead to
• Social problem like-job loss
• Alcohol/ drug abuse
• Marital break ups
• Domestic crime
• Social conflicts
• suicide

42. Treatment of BPD
• Medicinal
• Cognitive behavioral therapy (CBT)
• Family-focused therapy
• Interpersonal and social rhythm therapy
• Psychoeducation

43. Homoeopathic Medicines for BPD
• Agaricus
• Anacardium
• Aur.Met
• Crocus
• Hyos
• Ignatia
• Lachesis
• Phosphorus
• Platina
• Pulsatilla.