This document provides an overview of bipolar disorder, including its prevalence, classification, symptoms, diagnosis, and treatment. Some key points: - Bipolar disorder affects around 2% of the world population and is the 6th leading cause of disability. It involves periods of mania/hypomania and depression. - It is classified into Bipolar I, II, and cyclothymia based on the severity and duration of manic/hypomanic and depressive episodes experienced. - Symptoms of mania/hypomania involve elevated mood, decreased need for sleep, racing thoughts, distractibility, and risk-taking behaviors. Depressive episodes involve symptoms like low mood, loss

1. BIPOLAR DISORDER
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2. OUTLINE
Intro/History
Symptomatology and diagnosis
Etiopathogenesis
Course
Treatment
 NICE
 Individual more recent evidence
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4. BIPOLAR DISORDER
Common illness affecting 2% of the world population (5% if one includes spectrum disorders)
Lifetime prevalence – 1%
6th leading cause of medical disability in the developed nations
Bipolar I – equal in males and females
Bipolar II – more in females

5. HISTORY – TERMS FOR MRCPSYCH

7. SYMPTOM DIMENSIONS IN
MOOD/PSYCHOSIS

8. CLASSIFICATION OF MOOD DISORDERS
Bipolar I
Bipolar II
Cyclothymia
Unipolar
single episode
Dysthymia
Unipolar
recurrent‘Unipolar’
‘Bipolar’

9. SYMPTOMATOLOGY - MANIA
Persistently elevated, expansive, or irritable mood, lasting at least 1 week
Three (or more) of the following symptoms (4/9 in ICD)
 inflated self-esteem or grandiosity
 decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
 Pressure of speech
 flight of ideas or subjective experience that thoughts are racing
 distractibility
 increase in goal-directed activity or psychomotor agitation
 excessive involvement in pleasurable activities that have a high potential for painful
consequences

10. SYMPTOMATOLOGY – HYPOMANIC EPISODE
Same symptomatology as mania
Duration – 4 days
Change noticeable by others
No significant socio-occupational disturbance
No Hospitalisation
No psychotic symptoms

11. SYMPTOMATOLOGY – MIXED EPISODE
The criteria are met both for a manic episode and for a major depressive episode
(except for duration) nearly every day during at least a 1-week period.
Socio - occupational deterioration
The symptoms are not due to the direct physiological effects of a substance (e.g., a
drug of abuse, a medication, or other treatment) or a general medical condition
(e.g., hyperthyroidism).

12. Copyright © 2009 Blackwell Publishing Ltd. Published by Munksgaard International Publishers Ltd. 2
Medicating mood with maintenance in mind: bipolar
depression pharmacotherapy.
Malhi, Gin; Adams, Danielle; Berk, Michael
Bipolar Disorders. 11 Sup 2:55-76, June 2009.
DOI: 10.1111/j.1399-5618.2009.00711.x
SYMPTOMATOLOGY - DEPRESSION

14. ALGORITHM FOR DIAGNOSIS

15. SUMMARY OF DSM-IV-TR
CLASSIFICATION OF BIPOLAR DISORDERS
* Symptoms do not meet criteria for manic and depressive episodes.
Bipolar features
that do not meet
criteria for any
specific bipolar
disorders
At least 2 years of
numerous periods
of hypomanic and
depressive
symptoms*
One or more
major depressive
episodes
accompanied
by at least one
hypomanic
episode
FEMALE>MALE
One or more
manic or mixed
episodes, usually
accompanied by
major depressive
episodes
MALE=FEMALE
Bipolar Disorder
Not Otherwise
Specified
CyclothymicBipolar IIBipolar I
First, ed. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Rev.
Washington, DC: American Psychiatric Association; 2000:345-428.