Bipolar disorder is diagnosed when a person experiences periods of depression and periods of mania. Mania involves an elevated or irritable mood lasting at least one week accompanied by symptoms like grandiosity, distractibility, decreased sleep, and more goal-directed activity. Bipolar I disorder often starts with depression and can affect people of any age. Prognosis is poorer than for major depressive disorder, as around 40-50% of people with bipolar I disorder may experience a second manic episode within two years. Treatment involves both acute and long-term phases, using medications like lithium and valproate to treat mania and antidepressants to treat depressive symptoms.

1. BIPOLAR DISORDER
CHAPTER 15

2. Bipolar DIsorder
 Diagnosed when a person experiences symptoms of
depression at sometimes and symptoms of mania at
others.
 Mania: Elevated or irritable mood lasting at ;east 1 week
accompanied by three or more of the following symptoms:
 Grandiosity
 Distractibility
 Decreased sleep
 More goal-directed activity or psychomotor agitation
 Belief that there is pressure to keep talking
 Subjective expression of racing thought
 Excessive involvement in pleasurable activities, that have high
potential for painful consequences.

3. Bipolar I Disorder
 Most often Starts with depression
 75% of the time in women
 67% of the time in men
 Recurring disorder
 Can affect very young people as well as older people

4. Bipolar I Disorder:Prognosis
 Prognosis is poor compared to major depressive disorder
 40% to 50% of people with B1D may have a 2nd manic
disorder within 2 years of the first one.
 Related to:
 Premorbid poor occupational status
 Alcohol dependence
 Psychotic features
 Depressive features
 Male gender

5. Bipolar II Disorder
 Not widely studied
 Preliminary data indicates a stable diagnosis
 No change in 5 years
 Chronic condition that warrants long-term
treatment strategies.

6. Treatment
 B1D
 Prophylactic treatment with lithium
 Improves course and prognosis of disorder
 Only 50% to 60% achieve significant control with
lithium.
 Treatment of depressive symptoms with
antidepressants.
 See Depression and Suicide ppt. Antidepressants table
15.1-36 page 558 Kaplan & Sadock

7. Treatment
 Pharmacological treatment is divided into acute and
maintenance phases
 Involves formulation of different strategies
 Treatment of mania, hypomania or depression

8. Treatment: Acute Mania
 Lithium Carbonate
 Prototype mood stabilizer
 Action can be slow
 In early phases of treatment, usually supplemented with atypical
antipsychotics, mood stabilizing anticonvulsants or high potency
benzodiazepines.
 Therapeupic levels of lithium
 0.6 to q.2 mEq/L
 Valproate
 Only indicated for acute mania
 Typical doses: 750 to 2500 mg per day