these are the slides about bipolar.

1. BIPOLAR DISORDERBIPOLAR DISORDER
BY T.S MABUNDA.BY T.S MABUNDA.

2. BIPOLAR AFFECTIVE DISORDERBIPOLAR AFFECTIVE DISORDER Mania / HypomaniaMania / Hypomania
 Bipolar DepressionBipolar Depression
How to identify (DSM IV)How to identify (DSM IV)
a.a. Expensive, elated, irritable, elevated mood atExpensive, elated, irritable, elevated mood at
least for one week.least for one week.
b.b. Delusions of grandeurDelusions of grandeur
c.c. Pressure of speech / flight of ideasPressure of speech / flight of ideas
d.d. Decrease SleepDecrease Sleep
e.e. Excessive involvement in pleasurable activitiesExcessive involvement in pleasurable activities
f.f. DistractibilityDistractibility
g.g. Psychomotor agitation / increase in goalPsychomotor agitation / increase in goal
directed activitydirected activity

3. EPIDIOMOLOGY
 Life time risk for bipolar disorder is 1%.
 Life time risk for 1st
degree relatives of
patients with bipolar disorder is about
10%.
 Prevalence in men and women is the
same.
 Mean age of onset is about 21 years
 Bipolar disorder is highly co-morbid with
other disorders, like anxiety disorder and
substance misuse disorder.

4. CASE HISTORYCASE HISTORY
Saba Agha, 20 years of age,Saba Agha, 20 years of age,
wellkempt with good rapport andwellkempt with good rapport and
intense eye contact, irritable,intense eye contact, irritable,
quarrelsome and decreasedquarrelsome and decreased
sleep for the last one week.sleep for the last one week.
After quarreling with her fatherAfter quarreling with her father
she left home and she was notshe left home and she was not
on any treatment at the time ofon any treatment at the time of
admission.admission.

5. PAST PSYCHIATRIC HISTORYPAST PSYCHIATRIC HISTORY
 Total duration of illness 5-years.Total duration of illness 5-years.
 Considered immoral and bad girl byConsidered immoral and bad girl by
the family instead of seekingthe family instead of seeking
treatment.treatment.
 Indulged into a relationship andIndulged into a relationship and
married against his father’s will.married against his father’s will.
 Could not maintain good maritalCould not maintain good marital
relationship and shifted to the hostelrelationship and shifted to the hostel
and indulged into addiction,and indulged into addiction,
ultimately brought to PIMH.ultimately brought to PIMH.

6. FAMILY HISTORYFAMILY HISTORY
 Strict, short tempered and disciplinerStrict, short tempered and discipliner
father.father.
 Not allowed to attend school.Not allowed to attend school.
 Frequently beaten upFrequently beaten up
 Positive family history of moodPositive family history of mood
disorder.disorder.

7. PRECIPITATING FACTORSPRECIPITATING FACTORS
This episode was precipitated byThis episode was precipitated by
 Quarrel with fatherQuarrel with father
 Separation from her daughter andSeparation from her daughter and
husband.husband.
 AddictionAddiction

8. PREDISPOSING FACTORSPREDISPOSING FACTORS
 Strong family history of moodStrong family history of mood
disorder in grandmother & auntdisorder in grandmother & aunt
(both paternal).(both paternal).
 Short tempered strict father.Short tempered strict father.
 Stressful family environment.Stressful family environment.

9. PERPETUATING FACTORSPERPETUATING FACTORS
 Poor family support.Poor family support.
 Conflict of father and husband leadConflict of father and husband lead
to marital disharmony.to marital disharmony.
 Poor compliance of treatment.Poor compliance of treatment.

10. TREATMENTTREATMENT
PHARMACOLOGICAL TREATMENTPHARMACOLOGICAL TREATMENT
 AntipsychoticsAntipsychotics
e.g. Haloperidol, Chlorpromazine &e.g. Haloperidol, Chlorpromazine &
ResperidoneResperidone
 SedativesSedatives
e.g. Lorezepam, diazepam & alprezolame.g. Lorezepam, diazepam & alprezolam
 Mood stabilizerMood stabilizer
e.g. Carbamezapine, Sodium Valporate &e.g. Carbamezapine, Sodium Valporate &
TopiromateTopiromate
 Depot InjectionsDepot Injections
e.g. Flupenthixole.g. Flupenthixol
 ProcyclidineProcyclidine
 ECTECT

11. TREATMENTTREATMENT
PSYCHOLOGICAL TREATMENTPSYCHOLOGICAL TREATMENT
Individual TherapyIndividual Therapy
Cognitive TherapyCognitive Therapy
Family TherapyFamily Therapy
Family CounselingFamily Counseling

12. TREATMENTTREATMENT
SOCIAL TREATMENTSOCIAL TREATMENT
 Interpersonal conflictsInterpersonal conflicts
Amongst the family should be resolved.Amongst the family should be resolved.
Differences between her in laws and fatherDifferences between her in laws and father
should be resolvedshould be resolved
Her husband and parents should be toldHer husband and parents should be told
about her mental illness and guidelinesabout her mental illness and guidelines
should be given regarding her treatmentshould be given regarding her treatment
and follow-ups.and follow-ups.

13. PROGNOSISPROGNOSIS
 If the marital problems improve thenIf the marital problems improve then
immediate prognosis is good.immediate prognosis is good.
 However several predisposing factorsHowever several predisposing factors
noted above indicate that she maynoted above indicate that she may
develop further manic disordersdevelop further manic disorders
particularly at future times of stress.particularly at future times of stress.