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Bipolar affective disorder
- 1. Bipolar Affective Disorder Dr. Sujit Kumar Kar Assistant professor in Psychiatry, K.G.Medical University, Lucknow
- 2. Bipolar Affective Disorder What is it? Why it occurs? Who are affected? How to treat? When it occurs? Whom should you contact?
- 3. Bipolar disorder: disease burden • Recurrent lifelong condition associated with significant morbidity and mortality • Worldwide prevalence is about 1.5% • Even with maintenance therapy 5 year risk of a further episode is 73% • At least 25 % patients attempt suicide and around 10 to 15 % complete their attempt • Comorbid psychiatric and neurological disorders are prevalent • Panic disorder • Social phobia • Obsessive compulsive disorder • Post traumatic disorder International Journal of Neuropsychopharmacology 2004;7:507-22
- 5. BPD is a Progressive Disorder
- 8. Episode Characteristics Depression Mania Hypomania Mixed With psychotic symptoms Without psychotic symptoms Brief episodes Long episodes Rapid cycling Ultra rapid cycling
- 10. Genetic linkage in affective disorders Current estimates of concordance for bipolar disorder range between 65 and 100 percent in MZ twins and between 10 and 30 percent in DZ twins, indicating that the disorder is highly heritable (between about 60 and 80 percent). Several studies have shown that bipolar disorder is substantially more heritable than unipolar major depression, which has an estimated heritability between 30 and 40 percent.
- 11. Clinical assessment • History taking • Mental status examination • General / systemic examination Clinical severity of depression Suicidal risk Co-morbidity (if any) LOOK FOR FORMULATION OF MANAGEMENT PLAN
- 14. Proposed Nomenclature for Mood Stabilizers • Class A: Agents that stabilize mood “from Above baseline”. These agents possess marked antimanic properties without causing a worsening of depression e.g. lithium, valproate, divalproex, atypical antipshychotics and electroconvulsive therapy • Class B: Agents that stabilize mood “from Below baseline”. These agents possess marked antidepressant properties without inducing switches into mania or episode acceleration e.g. lamotrigine, lithium, electroconvulsive therapy Ketter TA et al. J Clin Psychiatry 2002; 63: 146-151
- 15. Proposed Nomenclature for Mood Stabilizers Ketter TA et al. J Clin Psychiatry 2002; 63: 146-151 Lamotrigine
- 16. Electroconvulsive therapy •Safe •Recommended for suicidal/ severely depressed patients •Quick response
- 17. Duration of treatment • Single episode • Second episode • Multiple episodes
- 18. Factors that decide treatment • Number of episodes • Nature of episode • Severity of episode • Family history • Substance use • History of compliance • Organicity • Co-morbidity • Past response to treatment
- 19. Summary Bipolar Affective Disorder What is it? Why it occurs? Who are affected? How to treat? When it occurs? Whom should you contact?