Bipolar+Disorder

=Bipolar Disorder=

What it is
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe with a lifetime prevalence of up to 4%. The recurring nature of the condition gradually takes its toll in terms of the patient's capacity to maintain relationships, career and school with up to 10-20% of all patients ending their life by their own hand.

Symptoms
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called **episodes** of mania and depression.

//Bipolar I disorder// - at least one episode of mania (current or past) - usually (but not necessarily) episodes of depression

//Bipolar II disorder// - episodes of hypomania and depression - no manic episodes

Signs and symptoms of //mania// (or a //manic episode//) include: Hypomania is a pathologically elevated (or irritable) mood lasting at least 2-4 days. While mood and behaviour are distinctly different from normal, functioning is not severely impaired. Psychotic features do not occur and hospitalisation is unnecessary.
 * Increased energy, activity, and restlessness
 * Excessively “high,” overly good, euphoric mood
 * Extreme irritability
 * Racing thoughts and talking very fast, jumping from one idea to another
 * Distractibility, can’t concentrate well
 * Little sleep needed
 * Unrealistic beliefs in one’s abilities and powers
 * Poor judgment
 * Spending sprees
 * A lasting period of behavior that is different from usual
 * Increased sexual drive
 * Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
 * Provocative, intrusive, or aggressive behavior
 * Denial that anything is wrong
 * Delusions or hallucinations

Signs and symptoms of //depression// (or a //depressive episode//) include:
 * Lasting sad, anxious, or empty mood
 * Feelings of hopelessness or pessimism
 * Feelings of guilt, worthlessness, or helplessness
 * Loss of interest or pleasure in activities once enjoyed, including sex
 * Decreased energy, a feeling of fatigue or of being “slowed down”
 * Difficulty concentrating, remembering, making decisions
 * Restlessness or irritability
 * Sleeping too much, or can’t sleep
 * Change in appetite and/or unintended weight loss or gain
 * Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
 * Thoughts of death or suicide, or suicide attempts

How to Treat
//Acute treatment of Mania// - Hospitalisation for protection for themselves and the public  - Relapses due to poor medication compliance (check serum levels), substance abuse, antidepressants, stressful life events  - 1st : lithium, sodium valproate, carbamazepine, olanzapine delay in onset of about a week  - 2nd : concurrent (or adjunctive) antipsychotic or benzodiazepine (combination/separate but not 2 antipsychotics) – to stabilise until mood stabiliser effects occurs  - Lithium is the drug of choice for treatment and prophylaxis of acute mania. - There is good evidence to support the use of valproate and carbamazepine as mood stabilisers. They are increasingly used as alternatives when lithium is considered too dangerous (in unreliable patients) or is poorly tolerated or ineffective; they are sometimes used with each other or with lithium. Concentrations of carbamazepine correlate poorly with mood stabiliser effect, but evidence suggests that the valproate concentration needed for mood stabilisation is similar to that used for seizure disorders. Valproate and carbamazepine also appear to be particularly suitable for those with rapid cycling illness (4 or more episodes a year). [|Read about bipolar disorder test].

//Psychological interventions// - Educational techniques empower the patient to take responsibility for the management of their illness and has been shown to reduce relapse and improve social functioning and employment. - Cognitive therapy is aimed at improving skills in managing stress and symptoms, and in identifying early warning signs of impending relapse, and teaching skills to challenge and alter unhelpful thinking styles. - Interpersonal and social rhythm therapy teaches patients to regulate their social habits, sleep patterns and daily routines at times of stress.

Other advice

 * all antidepressants may provoke mania or rapid cycling pattern, particularly in patients with bipolar disorder
 * corticosteroids, ACE inhibitors, dopaminergic agents (eg levodopa, bromocriptine) and isoniazid, as well as illicit stimulant drugs, may also induce mania
 * compliance with mood stabilisers can be poor, as patients may lose insight during manic episodes
 * it is preferable to use only one mood stabiliser drug, although in difficult cases combination treatment may be necessary

Additional Resources
[|Australian Prescriber - Bipolar Treatments] [|National Institute of Mental Health - Bipolar Disorder] [|AMH - Bipolar Disorder] [|Notes from TG - Bipolar Disorder]: talks about all the different medications used