It is also known as manic-depressive disorder
Bipolar disorder is a serious mental illness that is
characterized by extreme mood swings from mania to
It affects about 0.6-0.9% of the general population,
and it occurs in males and females equally.
It can result in damaged relationships, poor job or
school performance and even suicide. But it can be
treated and people with the illness can lead full and
People with BD are also at higher risk for thyroid
disease, migraine, heart diseases, diabetes, obesity
and other physical illnesses.
•200 CE First reports
•1913 Emil Kraepelin
•1930’s ECT first used
•1949 Lithium first used
•1950 Chlorpromazine first used
•1952 Genetic link recognized
•1980 Bipolar Disorder term adopted
•1995 Depakote approved for BP
•2003 First atypical approved for BP
Main Distinction: unipolar or bipolar
Unipolar: only one end of the emotion spectrum
Major Depressive Episode
Dysthymia: mild, chronic form of depression
Peak age of onset is adolescence through early
• Onset of first manic episode after age 40 years is
a “red flag” to consider substance use or general
Lifetime suicide rates range from 10-15%
• Depression is more common in fall, winter and
• Mania is more common in summer
The exact cause of bipolar disorder is unknown.
Experts believe there are a number of factors that
work together to make a person more likely to
develop the condition.
Chemical imbalance in the brain e.g.
noradrenaline, serotonin and dopamine
Genetics: BD is frequently inherited, with genetic
factors accounting for about 80% of the cause of
Environmental factors e.g. stress, seasonal
changes, substance abuse, sleep deprivation,
medications (like antidepressants) etc.
EVIDENCE FOR HERITABILITY OF
Family Studies-First degree relatives are 8 to 18
times more likely to have Bipolar I
2 to 10 times to have MDD.
Risk is 25% if one parent has illness, and 50% to
75% with both parents affected
Twin Studies- Concordance rate in MZ twins is
33-90%, while in DZ is 5-25%
Symptoms of Manic episode
A long period of feeling “high” or overly happy
Talking very fast, jumping from one idea to
Having racing thoughts
Being easily distracted
Increasing activities such as taking a new
Sleeping little or not being tired
High sex drive
Symptoms of Depressive
An overly long period of feeling sad or hopeless
Loss of interest in activities once enjoyed, including
Feeling tired or “slowed down”.
Having problems concentrating, remembering and
Being restless and irritable
Changing eating or sleeping habits
Thinking of death or suicide or attempting suicide
There are several types of BD, all involves
episodes of depression and mania to a degree.
Bipolar I disorder
Bipolar II disorder
Bipolar disorder not otherwise specified (BD-
Bipolar I disorder
This is defined by manic episode or mixed episode
that last at least 7 days or by mania symptoms that
are so severe that the person needs immediate
Usually depressive episodes occurs as well,
typically lasting at least 2 weeks but not required for
Bipolar II disorder
• It is considered to be the milder form of BD
• According to American Psychiatric Association (APA),
the diagnosis for Bipolar II disorder involves a
minimum of one hypomanic episode lasting at
least 4days and one or more episode of major
• They usually suffer lower grade of hypomania, if not
treated, it can lead to full mania
• The DSM lists school failure, occupational failure, and
divorce as social problems associated with Bipolar II
• Bipolar II symptoms tend to occur more frequently in
women than men. When it does occur in males, the
number of hypomanic episodes typically equals that
of depressive episodes whereas depression tends to
dominate in women.
It is a milder form of BD
It is characterized by episodes of hypomania as
well as mild depression for at least 2 years.
However, the symptoms do not meet the diagnostic
requirements for any other type of BD
Individuals with Cyclothymia do not remain symptom-
free for more than two months at a time
Substance abuse may be associated with
Cyclothymia, as well as sleep disorders.
The condition typically has a slow, gradual, and
progressive onset and a chronic course once
There is a 15-50% chance that cyclothymic
individuals will go on to develop bipolar I or II
disorders in later life.
Bipolar Disorder NOS
It is a bipolar condition that does not neatly fit into the
symptomology of BD I, BD II or cyclothymia
If you are diagnosed with this disorder, you are likely to be
re-evaluated for one of the other types of BD when you
have another episode
Examples given by DSM to give diagnosis includes;
I. Having symptoms of mania and depression but the
episodes are too short to qualify as an actual episode
II. Having many episodes of hypomania, but not had a
III. Having a manic or mixed episode, but you were
previously diagnosed with a psychotic disorder or
IV. Having symptoms of hypomania and depression, but
they don’t last long enough to qualify as cyclothymia
V. It looks like you have a BD, but your doctor thinks your
symptoms might be caused by drugs, alcohol or a
general medical condition
This is a severe form of BD
It occurs when a person has 4 or more episodes
of major depression, mania, hypomania or mixed
states all within a year
RC-BD seems to be more common in people who
had their first bipolar episode at a younger age
It affects more women than men
• BD may also be present in a mixed state in
which you might experience both mania and
depression at the same time.
• During a mixed state, you might feel very
agitated, have trouble sleeping, experience major
changes in appetite and have suicidal thoughts
• People in the mixed state may feel very sad or
hopeless while at the same time feel energized.
Sometimes a person with severe episodes of mania
and depression has psychotic symptoms too such as
hallucinations and delusions.
The psychotic symptoms tends to reflect the person’s
a) If you are having psychotic symptoms during manic
episode, you may believe you are a famous person,
have a lot of money or have special powers
b) If you are having psychotic symptoms during
depression, you might believe you are ruined and
penniless or have committed a crime
• As a result, people with BD who are having psychotic
symptoms are sometimes misdiagnosed with
Patients with bipolar II disorder are more frequently
misdiagnosed with unipolar disorder for the
Often the patient feels remarkably well when
hypomanic and he/she is therefore unlikely to
spontaneously report these episodes and may
even deny them when directly questioned.
Patients with hypomania do not present with
psychotic symptoms and they are not
hospitalized, so there may be no indication or
records of a previous hypomanic episode
BD and Substance Abuse
• Substance abuse is very common with people with BD, but
the reasons for this link is unclear.
• Some people with BD may try to treat their symptoms with
alcohol or drugs.
• However, substance abuse may trigger or prolong bipolar
symptoms and their behavioral control problems
associated with mania can result in a person drinking too
• According to the most recent literature on substance abuse
and bipolar disorder, these two problems occur together so
frequently that all young people with a bipolar diagnosis
should also be assessed for drug and alcohol problems.
• Those who experience mixed states or rapid cycling have
the highest rate of danger from substance abuse — the
discomfort a person feels in these moods is so great that
he/she may be willing to do or take almost anything to
make it stop.
Bipolar disorder cannot be cured, but it can be
treated effectively over the long-term. Proper
treatment helps many people with BD—even those
with the most severe forms of the illness—gain
better control of their mood swings and related
symptoms. But because it is a lifelong illness, long-
term, continuous treatment is needed to control
symptoms. However, even with proper treatment,
mood changes can occur
Treatment is more effective if you work closely with
a doctor and talk openly about your concerns and
choices. An effective maintenance treatment plan
usually includes a combination of medication and
This is the key in stabilizing BD
Initial treatment of mania consist of Lithium or Valproic
If the patient is psychotic, a neuroleptic medication
(antipsychotics) is also given
Long-acting benzodiazepines may be used for
treating agitation. However, it should be used with
caution in patients with a history of substance abuse
because of the addictive potential of these agents.
When the patient with BD becomes depressed, an
SSRI or bupropion is recommended. The use of
tricyclic antidepressants should be avoided because
of the possibilities of inducing rapid-cycling of the
Note that taking only an antidepressant can
increase your risk of switching to mania or
hypomania, or of developing rapid-cycling
symptoms. To prevent this switch, it is usually
required that the patient takes a mood-stabilizing
medication at the same time as an antidepressant.
When done in combination with medication,
psychotherapy can be an effective treatment for BD. It
can provide support, education, and guidance to people
with BD and their families. Some psychotherapy
treatments used to treat BD include:
Cognitive behavioral therapy (CBT), which helps
people with BD learn to change harmful or negative
thought patterns and behaviors.
Family-focused therapy, which involves family
members. It helps enhance family coping strategies,
such as recognizing new episodes early and helping
their loved one. This therapy also improves
communication among family members, as well as
Interpersonal and social rhythm therapy, which
helps people with BD improve their relationships
with others and manage their daily routines.
Regular daily routines and sleep schedules may
help protect against manic episodes.
Psychoeducation, which teaches people with
BD about the illness and its treatment.
Psychoeducation can help you recognize signs of
an impending mood swing so you can seek
treatment early, before a full-blown episode
occurs. Usually done in a group, psychoeducation
may also be helpful for family members and
• For cases in which medication and psychotherapy do not work,
electroconvulsive therapy (ECT) may be useful. ECT, formerly known as
"shock therapy," once had a bad reputation. But in recent years, it has
greatly improved and can provide relief for people with severe bipolar
disorder who have not been able to recover with other treatments.
• Before ECT is administered, a patient takes a muscle relaxant and is put
under brief anesthesia. He or she does not consciously feel the
electrical impulse administered in ECT. On average, ECT treatments
last from 30–90 seconds. People who have ECT usually recover after
5–15 minutes and are able to go home the same day.
• Sometimes ECT is used for bipolar symptoms when other medical
conditions, including pregnancy, make the use of medications too risky.
ECT is a highly effective treatment for severely depressive, manic, or
mixed episodes. But it is generally not used as a first-line treatment.
• ECT may cause some short-term side effects, including confusion,
disorientation, and memory loss. People with bipolar disorder should
discuss possible benefits and risks of ECT with an experienced doctor.