Bipolar Disorder

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					Bipolar Disorder-
Assessment
B. Anthony Lindsey, MD
Professor and Vice Chair
UNC Department of Psychiatry
Bipolar Disorder

  Characteristics of a Manic Episode
   A distinct period of abnormally and persistently elevated,
    expansive or irritable mood
   During the period of mood disturbance, at least three of
    the following symptoms have persisted (four if the mood
    is only irritable) and have been persistent to a significant
    degree
     – Inflated self esteem or grandiosity
     – Decreased need for sleep
     – More talkative than usual or pressure to keep talking
     – Flight of ideas or subjective experience that thoughts
        are racing
Characteristics (Cont.)
 – Distractability, i.e. attention too easily drawn to
   unimportant or irrelevant external stimuli
 – Increase in goal-directed activity or psychomotor
   agitation
 – Excessive involvement in pleasurable activities
   which have a high potential for painful
   consequences, e.g. unrestrained buying sprees,
   sexual indiscretions, or foolish business
   investments
Characteristics (Cont.)
   Mood disturbance sufficiently severe to cause marked
    impairment in occupational functioning or in usual
    social activities or relations with others, or to
    necessitate hospitalization to prevent harm to self or
    others
   At no time during the disturbance have there been
    delusions or hallucinations for as long as two weeks
    in the absence of prominent mood symptoms
   Not superimposed on schizophrenia,
    schizophreniform disorder, or delusional disorder or
    psychotic disorder NOS
   The disturbance is not due to the physiologic effects
    of a substance or general medical disorder
Presentations of Bipolar Disorder
       Manic

       Depressed

       Mixed
Types

   Type I - manic/mixed episode +/-
    major depressive episode

   Type II - hypomanic episode + major
    depressive episode
Epidemiology

  Lifetime prevalence
   Type I - 0.7 - 0.8%
   Type II - 0.4 - 0.5%
      – Equal in males and females
      – Increased prevalence in upper
        socioeconomic classes
     Age of Onset
      – Usually late adolescence or early
        adulthood. However some after age 50.
        Late onset is more commonly Type II.
Genetics

   Greater risk in first degree relatives
    (4-14 times risk)
   Concordance in monozygotic twins
    >85%
   Concordance in dizygotic twins – 20%
Secondary Causes of Mania
Toxins
   Drugs of Abuse
    – Stimulants (amphetamines, cocaine)
    – Hallucinogens (LCD, PCP)
   Prescription Medications
    – Common: antidepressants, L-dopa,
      corticosteroids
Neurologic
   Nondominant frontal CVA
   Nondominant frontal tumors
   Huntington’s Disease
   Multiple Sclerosis
Secondary Causes of Mania
(Cont.)

Infectious
   Neurosyphilis
   HIV
Endocrine
   Hyperthyroidism
   Cushing’s Disease
Treatment
   Education and Support
   Medication
    Acute mania
         Lithium, Carbamazepine, Valproate,
    Lamotrigine, antipsychotics,
    benzodiazepines

     Long Term Mood Stabilization
          Lithium, Carbamazepine, Valproate,
    Lamotrigine, possibly atypical
    antipsychotics
Course

   Acute Episode
    – Manic - 5 weeks
    – Depressed - 9 weeks
    – Mixed - 14 weeks
   Long Term
    – Variable - most cover fully
    – Mean number of lifetime episodes 8-9
Cyclothymic Disorder

Characteristics
   For at least two years (one for children and
    adolescents) presence of numerous
    Hypomanic Episodes and numerous periods
    with depressed mood or loss of interest or
    pleasure that did not meet criterion A of a
    Major Depressive Episode
   During a two year period (one year in
    children and adolescents) of the
    disturbance, never without hypomanic or
    depressive symptoms for more than a two
    month time
Characteristics (Cont.)

   No clear evidence of a Major Depressive
    Disorder, or Manic Episode during the first
    two years of the disturbance (or one year
    for children and adolescents)
   Not superimposed on a chronic psychotic
    disorder, such as schizophrenia or
    Delusional Disorder
   Not due to the direct physiologic affects of a
    substance or a general medical condition
Epidemiology

   Lifetime prevalence 0.4 – 1.0 %
     same for males and females
   Age of onset
    – Usually in adolescence or early adulthood
   Genetics
    – Major Depression and Bipolar Disorder
      more common in first degree relatives
Cyclothymic Disorder

Secondary causes of cyclothymic
 disorder
   Bipolar Disorder
   Mood disorders due to a general medical
    condition

Treatment
   Initiation of biologic treatment is dependent
    on the degree of impairment
   If treatment is indicated, it is similar to that

				
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posted:9/16/2012
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