Bipolar Disorder is a serious Mental Illness which can be managed with the help of medication and psychotherapy. Diagnosis is the first step but unfortunately it typically happens 10 years after onset of first symptoms. Mood swings between mania, hypomania and depression characterise Bipolar Disorder.

1. Dr Milan Balakrishnan
Consultant Psychiatrist
Bombay Hospital
Masina Hospital

2. Case of ISK

4.  Depressed, irritable mood or significant decreased interest
in pleasurable activates present for at least two weeks.
 Loss of weight, increase in appetite, or decrease in
appetite
 Too much sleep, can’t stay or fall asleep
 Appearing to have slow movements or restless
movements.
 Feeling worthless, or experience inappropriate guilt
 Little – no energy
 Problems concentrating and making decisionsThoughts of
death, thoughts of suicide, or a suicide attempt

7.  Complex
 Multifactorial
 Multiple genes involved
 Symptom clusters- Mood
 Biological factors
 Closeness to schizophrenia

10.  Norepinephrine-Alertness,concentration
 Serotonin-arousal , sleep and low mood
 Dopamine can affect “self-esteem; may
contribute to abnormal mood states, such as
elation and melancholia; and may result in
marked variations in activity/hyperactivity
and pressured speech seen in mania and
hypomania”

11.  2-5 %
 15-25 age group
 Delay between first appearance of symptoms
and diagnosis- 10 years

12.  I wish the answer was NO
 Nobody given a choice would want to take
meds
 Missing meds can increase risk of episodes

13.  Mood Stabilizers
 Antipsychotics
 Antidepressants
 Anti-anxiety

14.  Choose the right medication
 When in doubt discuss with doctor

15.  Link with daily activities
 Keep in office bag
 Travel packs
 Make family member check with you

16.  Temptation to discontinue –high
 Reflect on reasons to continue
Eg What does the episode do to you.

17.  Family focused therapy
 interpersonal psychotherapy (IPT), a therapy that
directs attention to the interpersonal confl icts
and role challenges ,sleep wake cycles
 CBT managing activity levels in relation to long-
term goals, enhancing communication and
problem solving, enhancing stress management,
and helping manage the negative or overpositive
thinking patterns

18.  Stress- conflicts, even positive events
 Sleep
 Maintaining regular sleep patterns can help
stabilize your mood.
 Sleep and wake up same time even on
weekends

19.  Keep stress out of the bedroom
 Use muscle relaxation techniques in bed
 Never compete to get to sleep
 Give yourself time to unwind before sleep
 Use a regular daytime cycle to help with
nighttime sleep
 Adjust sleep cycle before travel

20.  Exercise
 Social Activities
 Relationship Activities
 Movies, Theater, and Recreation
 Hobbies
 Work-Related Activities

21.  Look at problem as you would help a friend
 Look at various options , weigh pros and cons
of each option
 Chose best try if convinced

22.  If you have bipolar disorder, it pays to limit
your drug and alcohol use

23.  Is there an event that you find bothersome?
 Write out the thoughts that occur to you about this
event, and the moods that go with this thought.
(thoughts) (moods)
 What is the evidence for and against this thought?
 Does the thought just feel true, or is there actual
evidence for this thought?
 Could this evidence support any other conclusions?
 What evidence suggests this thought is true?
 What evidence it is false
 Is there a more accurate thought you want to
substitute

24.  Seek help

26.  Dont let them get in the way of life goals
 Avoid win or lose thinking
 Avoid
just like last time
I can’t let her/him/them get away with this
They are always doing this to me
Enough is enough
I can’t let this happen again
I am always being treated this way
They always act this way

27.  You don’t get behind in life; you experience
life. Life events can always take a linear,
planned life or make it more unexpected,
more curvilinear, plot

28.  An advantage of mood charting is that you
become more familiar with the patterning of
your mood and your personal triggers for
mood changes.
 daily stressors
 medication doses.
 Disruptions in sleep

29.  Psychiatrist
 Therapist
 Support system
 Maintain well being

30.  Accept diagnosis
 Medication regular
 Mood charting
 Activity charting
 Improve communication
 Avoid anger, irritability’
 Avoid thought bias
 Watch for triggers
 Maintain treatment contract

31.  Contact me at~
 Email: dr.milanb@gmail.com