a disease in which patient sometimes feels mania and sometimes depressed ...it is a psychiatric illness.....symptoms last for 3-6 months...but it is curable with antidepressants and antipsychotics....
3. This disorder is characterized by repeated episodes in
which the patients mood and activity levels are
significantly disturbed, this disturbance consists of
mania and depression.
6. Classification:
1. bipolar affective disorder, current episode hypomanic
The current episode must fulfil the criteria for
hypomania
There must have been at least one other effective episode
(hypomanic, manic, depressive, or mixed) in the past
2. bipolar affective disorder, current episode manic
without psychotic symptoms
7. The current episode must fulfil the criteria for mania
without psychotic symptoms
There must have been at least one other effective
episode (hypomanic, manic, depressive, or mixed) in
the past
3. bipolar affective disorder, current episode manic with
psychotic symptoms
The current episode must fulfil the criteria for mania
with psychotic symptoms
8. There must have been at least one other effective
episode (hypomanic, manic, depressive, or mixed) in
the past
4. bipolar affective disorder current episode mild or
moderate depression
The current episode must fulfil the criteria for
depressive episode of either mild or moderate severity
There must have been at least one other effective
episode hypomanic, manic, or mixed affective episode
in the past
9. 5. bipolar affective disorder, current episode sever
depression without psychotic symptoms
The current episode must fulfil the criteria for severe
depression without psychotic symptoms
There must have been at least one hypomanic, manic or
mixed affective episode in the past
6. bipolar affective disorder, current episode severe
depression with psychotic symptoms
10. The current episode must fulfil the criteria for sever
depression with psychotic symptoms
There must have been at least one hypomanic, manic
or mixed affective episode in the past
7. bipolar affective disorder, current episode mixed
The patient has had atleast one manic, hypomanic or
mixed affective episode in the past and currently
exhibits either a mixture or a rapid alternation of
manic, hypomanic and depressive symptoms
11. 8. bipolar affective disorder, currently in remission
The patient has had atleast one manic, hypomanic or
mixed affective episode in the past and currently exhibits
either a mixture or a rapid alternation of manic,
hypomanic, depressive or mixed type but is not currently
suffering from any significant mood disturbance
9. other bipolar affective disorder
10. bipolar affective disorders unspecified
12. DIAGNOSTIC CRITERIA FOR
MANIC EPISODES
THREE TO FOUR OF THE FOLLOWING CRITERIA ARE REQUIRED
DURING THE ELEVATED MOOD PERIOD
Highly inflated or grandiose self-esteem
Decreased need for sleep, or rested after only a few hours of sleep
Pressured speech
Racing thoughts and flight of ideas
Easy distractibility, failure to keep attention
Increased goal-directed activity
High excess involvement in pleasurable activities (sex, travel, spending money)
General criteria for a manic episode require a period of elevated, expansive, or
irritable mood that lasts 1 week or requires hospitalization. A general medical
condition and substance abuse must be ruled out before these symptoms are
considered mania.
16. Psychotic Symptoms
Inflated self esteem
Feeling of grandiosity
Delusions
Delusions of perception
Flight of ideas and pressure of speech
Severe and sustained physical activity
Aggression or violence
18. Etiology
Genetic factors
Relatives of the patients with mood
disorders have more chances to suffer
from mood disorders.
Twin studies
In monozygotic twins 68% concordance
for bipolar disorder. In dizygotic twin
this is 23%.
Adoption studies
19. Family studies
20% in close relatives as compared to
7% in controls
Biochemical Abnormality
• Deficiency of Neurotransmitters
• Serotonin, Nor adrenaline, Dopamine.
• Endocrine Abnormality
20. High Cortisol output (morning peak is more
pronounced).
Dexamethasone suppression test (non suppression in
depression
Vulnerability Factors.
Loss of mother before 11 years of age
Having 3 or more children below 14 years of age
Lack of confiding relationship.
22. DIFFERENTIAL DIAGNOSIS
OF MANIA
May be induced by:
Antidepressant medications
Psychostimulants
Electroconvulsive therapy
Phototherapy
If the above occurs, the patient is diagnosed with
substance-induced mood disorder
24. TREATMENT GOALS
Treat and reduce the severity of acute episodes of
mania or depression when they occur
Reduce the frequency of episodes
Help the patient function possible b/w episodes
25. Treatment options
Antipsychotics
e.g. Haloperidol, Chlorpromazine & Resperidone
Sedatives
e.g. Lorezepam, diazepam & alprezolam
Mood stabilizer
e.g. Carbamezapine, Sodium Valporate & Topiromate
Depot Injections
Eg : flupenthixol
28. LONG TERM TREATMENT
CONTINUATION TREATMENT
Atypical antipsychotics decreases risk of manic relapse
Mood stabilizers + antipsychotics
29. MAINTENANCE
TREATMENT
LITHIUM
Prevents relapse of all mood disorders
Decreases in mortality from suicide
CARBAMAZEPINE
Efficacy in prophylaxis of bipolar
VALPROATE
For acute mania
LAMOTRIGINE
Prophylactic effect against depression
30. Lithium or Lamotrigine are the standard first line
treatment
Lithium works better for controlling manic states
Lamotrigine for bipolar depression