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Bipolar disorder for undergraduates

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Bipolar disorder for undergraduates

  1. 1. Bipolar I disorderDr. Mohamed AbdelghaniM.B.B.Ch., M.Sc., M.D. Psych.
  2. 2. Epidemiology The lifetime prevalence is 0.4-1.6%. The lifetime prevalence in monozygotictwin of patients is up to 90%. Male to Female ratio 1:1. Manic episode: more in males. Depressive episode: more in females.
  3. 3. Diagnosis Presence of one or more manic episodes with or withoutpresence of major depressive episodes. Manic episode: Elated mood or irritable mood for one week or more. If mood is elated (3) or more of the following must be present butif mood is irritable (4) or more of the following must be present: Inflated self-esteem or grandiosity. Decreased need for sleep. More talkative than usual. Flight of ideas. Distractability. psychomotor agitation. Loss of normal social and sexual inhibition. Excessive involvement in pleasurable activities that have a high potential forpainful consequences. Not substance-induced or not due to general medical condition. Significant impairment of occupational and social functioning.
  4. 4. Aetiology1) Neurotransmitter hypothesis: increased activity of biogenicamines serotonin, norepinephrine, and dopamine.2) Genetic theory: Increase the incidence of bipolar I disorder in subjects related toan affected person. Associations between bipolar I disorder and genetic markershave been reported for chromosomes 5, 11, X.3) Brain structure theory: Some patients showed enlarged cerebral ventricles. Magnetic resonance spectroscopy showed abnormal regulationof membrane phospholipid metabolism.4) Psychosocial theory:o Feeling of inadequacy and worthlessness are converted bymeans of denial, reaction formation and projection to grandiosedelusions.
  5. 5. Differential diagnosis1. Bipolar II disorder: Major depressive episodes with hypomanic episodes.2. Cyclothymic disorder: Numerous episodes of hypomania and numerousepisodes of depressive symptoms for at least 2 years. The symptoms are not sufficient to diagnose manicepisodes or major depressive episodes. Significant social and occupational impairment.3. Secondary mood disorder: Substance-induced mood disorder. Mood disorder due to general medical condition.
  6. 6. TreatmentI. HospitalizationII. PsychopharmacotherapyIII. E.C.T.IV. Psychotherapy
  7. 7. PsychopharmacotherapyA. For manic episodes: “Mood stabilizers”1)Lithium: It is the standard treatment of bipolar disorder. Therapeutic blood level is 0.8-1.2 mEq/litre. Toxic levels start after 1.5 mEq/litre.2)Anti-convulsants: Valproate, Carbamazepine, oxacarbazepine,....3)Atypical antipsychotics: All except Clozapine.
  8. 8. B. For major depressive episode: Lamotrigine Olanzapine plus Flouxetine “Symbyax” Quetiapine Antidepressant drugs should be used withcaution to avoid switching to mania.
  9. 9. Electroconvulsive therapy At least equal to lithium in the treatment of acute andsevere manic episodes. Limited to:1. Acute suicide.2. Severe mania with psychotic symptoms.3. Catatonia.4. Failure of medical ttt “Resistent Bipolar”.
  10. 10. Psychotherapy1) Cognitive therapy: to increase compliance withpharmacotherapy.2) Supportive therapy: with chronic patients whomay have significant interepisodic residualsymptoms and social dysfunction.3) Family therapy: if patient’s disorder is disruptingthe family stability, and because the disorder isstrongly familial.
  11. 11. http://www.slideshare.net/mabdelghaniAvailable at:Thank u

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