BIPOLAR

DISORDER
JI BAM DEEPAK B

VMUF
WHAT IS BIPOLAR DISORDER?

 also known as manic-depressive illness

 Bipolar disorder is a serious mental illness that is

characterized by extreme mood swings from mania to
depression.

 the cycles of bipolar disorder last for days, weeks, or months.

 SYPTOMS OF BIPOLAR DISORDER

 People with bipolar disorder experience unusually intense

emotional states that occur in distinct periods called “mood
episodes.”

 An overly joyful or overexcited state is called a manic episode,

and an extremely sad or hopeless state is called a depressive
episode.

 Sometimes, a mood episode includes symptoms of both

mania and depression. This is called a mixed state.
MANIA DEPRESSION

 Period lasts 1 week or less  Last at least 2 weeks of

if patient must be depressed mood or loss of
hospitalized. pleasure in nearly all
activities
HYPOMANIA

 Period of abnormally elevated, expansive, or irritable

mood lasting for 4 days plus 3 or 4 of the additional
symptoms as described in mania

 never suffer from delusions and hallucinations

 able to carry on with their day-to-day lives

 often escalates to full-blown mania or is followed by a

major depressive episode
DIFFERENCE BETWEEN MANIA
AND HYPOMANIA
 MANIA  HYPOMANIA
 Lasts at least 7 days  Lasts at least 4 days

 Causes severe impairment in  No marked impairment in

social or occupational social or occupational
functioning functioning

 May necessitate  Does not require

hospitalization to prevent hospitalization
harm to self or others

 No psychotic features
 May have psychotic features
 Prevalence

 SEX- bipolar I disorder has an equal prevalence among men and women. Manic
episodes are more common in men, and depressive episodes are more common in
women.
 AGE- The age of onset for bipolar I disorder ranges from childhood (as early as age
5 or 6 years) to 50 years or even older in rare cases, with a mean age of 30 years
 MARTIAL STATUS- . Bipolar I disorder is more common in divorced and single
persons than among married persons, but this difference may reflect the early
onset and the resulting marital discord characteristic of the disorder.
 SOCIOECONOMIC AND CULTURAL FACTORS- incidence of bipolar I disorder is
found among the upper socioeconomic groups. Bipolar I disorder is more common
in persons who did not graduate from college than in college graduates, however,
which may also reflect the relatively early age of onset for the disorder.
 COMORBIDITY- bipolar disorder, whereas men more frequently present with
substance use disorders, women more frequently present with comorbid anxiety
and eating disorders.
prevalence
etiology

I. GENETIC FACTOR
II. BIOCHEMICAL FACTOR
III. NEUROENDOCRINE FACTOR
IV. SLEEP STUDIES
V. BRAIN IMAGING
GENETIC FACTOR

 Family data indicate that if one parent has a mood disorder, a

child will have a risk of between 10 and 25 % for mood
disorder. If both parents are affected, this risk roughly doubles.
The more members of the family who are affected, the greater
the risk is to a child. The risk is greater if the affected family
members are first-degree relatives rather than more distant
relatives.

 DNA markers are segments of DNA of known chromosomal

location, which are highly variable among individuals. They are
used to track the segregation of specific chromosomal regions
within families affected with a disorder. When a marker is
identified with disease in families, the disease is said to be
genetically linked.
BIOCHEMICAL FACTOR

 Catecholamine's abnormality (norepinephrine, dopamine and serotonin)

in one or more sites at brain.
A. Norepinephrine-Patients with bipolar disorder commonly have decreased
levels of norepinephrine in the brain.
B. Dopamine- The data suggest that dopamine activity may be reduced in
depression and increased in mania
C. Serotonin-Depletion of serotonin may precipitate depression, and some
patients with suicidal impulses have low cerebrospinal fluid (CSF)
concentrations of serotonin metabolites and low concentrations of
serotonin uptake sites on platelets

 Acetylcholine and GABA may also play a role.

NEUROENDOCRINE FACTOR

 GROWTH HORMONE- is secreted from the

anterior pituitary after stimulation by NE and
dopamine. Secretion is inhibited by somatostatin,
a hypothalamic neuropeptide, and CRH.
Decreased CSF somatostatin levels have been
reported in depression, and increased levels have
been observed in mania.
SLEEP STUDIES

 Depression is associated with a premature loss of

deep (slow-wave) sleep and an increase in
nocturnal arousal. The latter is reflected by four
types of disturbance:
1) an increase in nocturnal awakenings,
2) a reduction in total sleep time
3) increased phasic rapid eye movement (REM)
sleep,
4) increased core body temperature
BRAIN IMAGING

 bipolar I disorder: among elderly adults,

hyperintensities appear to reflect the
deleterious neurodegenerative effects of
recurrent affective episodes. Ventricular
enlargement, cortical atrophy, and sulcal
widening also have been reported in some
studies.
Types

 There are four basic types of bipolar

disorder:
I. Bipolar I Disorder
II. Bipolar II Disorder
III. Cyclothymic Disorder (also called
cyclothymia)
IV. Other Specified and Unspecified Bipolar
and Related Disorders
Bipolar I disorder

 defined by manic episodes that last at

least 7 days, or by manic symptoms that
are so severe that the person needs
immediate hospital care. Usually,
depressive episodes occur as well,
typically lasting at least 2 weeks. Episodes
of depression with mixed features (having
depression and manic symptoms at the
same time) are also possible.
BIPOLAR II disorder

 defined by a pattern of depressive

episodes shifting back and forth with
hypomanic episodes, but no full-blown
manic or mixed episodes.
Cyclothymia

 is a mild form of bipolar disorder. People

who have cyclothymia have episodes of
hypomania that shift back and forth with
mild depression for at least two years.
However, the symptoms do not meet the
diagnostic requirements for any other type
of bipolar disorder.
 Other Specified and Unspecified
Bipolar and Related Disorders

 is diagnosed when a person has symptoms

of the illness that do not meet diagnostic
criteria for either bipolar I or II. The
symptoms may not last long enough, or
the person may have too few symptoms,
to be diagnosed with bipolar I or II.
However, the symptoms are clearly out of
the person’s normal range of behavior.
Treatment

 The pharmacological treatment of bipolar disorders is

divided into both acute and maintenance phase.
 Bipolar treatment, however, also involves the formulation
of different strategies for the patient who is experiencing
mania or hypomania or depression.
 Lithium and its augmentation by antidepressants
antipsychotic and benzodiazepines has been major
approach to the illness but 3 anticonvulsants mood
stabilizers – carbamazepine, valproate, and lamotrigine. –
have been added more recently as well as series of
atypical antipsychotics , most of which are approved
treatment of acute mania, one also for monotherapy of
acute depression.
Treatment

 Acute mania  Acute bipolar

 Lithium carbonate depression
 Valproate  Fixed combination
of olanzapine and
 Carbamazepine fluoxetine has
 Clonazepam and been shown to be
lorazepam effective.
Maintenance treatment

 Lithium, carbamazepine and valproic acid ,

alone or in combination are the most
widely used agents in the long term
treatment of patients with bipolar
disorder.
 Lamotrigine has prophylactic
antidepressants and potentially, mood
stabilizing properties.