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....

2. BIPOLAR DISORDERS
Presented by:
18,28,31,34,68

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.

4. Manic phase
Increase energy and activity

5. Depressive phase
Decrease energy and activity

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.

13. Symptomatolgy
Mania
Elevated mood
Increase in the quantity and speed of physical and
mental activity
Hypomania:
Lesser degree of mania
Mild elevation of mood

14. Increased energy
Marked feelings of wellbeing
Mental and physical efficiency
Talkativeness
Increased sociability
Over familiarity

15. Increased sexual energy
Decreased need for sleep
These are present but not to the extent that they disrupt
daily activities.

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

17. Depression
Depressive episode
Reduce concentration and attendance
Reduce self esteem
Self confidence
Ideas of guilt and unworthiness
Ideas and acts of self esteem and suicide
Disturbed sleep

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.

21. Psychological Theories
Personality
Organic Causes
a. Endocrine disorders.
b. Infections.
c. Anaemia.
d. Neurological Disorders.
e. Drugs.

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

23. Depressive disorder
Anxiety disorder
Schizophrenia
Dementia
Organic brain syndromes

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

26. Procyclidine
ECT

27. ANTIDEPRESSANTS
These alone are not recommended
First choice for antidepressants are bupropion or
paroxetine

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

31. PSYCHOLOGICAL TREATMENT
• Individual Therapy
• Cognitive Therapy
• Family Therapy
• Family Counseling

32. Carrie Fisher.
Known for her role as Princess Leia in the “Star
Wars” movie franchise, Fisher got diagnosed
with bipolar disorder at the age of 24