| name: | Bipolar Disorder |
| also known as: | Manic Depressive Disorder; Manic Depression Disorder; Bipolar I; Bipolar II; Cyclothymic Disorder; Rapid Cycling; Mania |
| also see: | Mood Disorder; Depression; Dysthymia; Seasonal Affective Disorder; Postpartum Depression; Schizophrenia; Suicide; Psychiatric Disorder; Hallucination; ICD; CPT |
| description: | Bipolar disorder, also called manic depressive disorder, consists of episodes of depression alternating with episodes of mania. Usually, a person begins with depression or unipolar disorder and after several years, develops bipolar disorder manifestations. Between episodes a person exhibits depressive moodiness and sometimes high energy activity. Bipolar disorder is further categorized: 1. Bipolar I: episodes of depression and mania or just mania (very rare) 2. Bipolar II: mainly episodes of depression with occasional low-grade mania called hypomania 3. Cyclothymic: hypomania alternating with depression (not as severe as bipolar I or II) 4. Rapid cycling: alternating mania and depression about 4 times per year (more common in women) Bipolar disorder has two peak occurrences, in childhood and adolescence where it might be confused with attention deficit disorder and in middle age. It occurs equally in men and women although rapid cycling is more common in women. Cause is unknown although possibilities include a brain abnormality (hippocampus brain), and brain chemical imbalance, also called brain neurotransmitter dysfunction, such as epinehrine dopamine or serotonin. Risk is increased in families (genetic) and in the months of spring and fall. Some researchers feel bipolar disorder is on the spectrum of schizophrenia through depression while others feel all three are distinct entities. Cyclothymic disorder as a category of bipolar disorder is not the same thing as cyclothymic personality disorder. Associated conditions: substance abuse (60%), ADHD, anxiety, anorexia, bulimia, obsessive compulsive disorder, social phobia, post-traumatic stress disorder. |
| signs & symptoms: | Symptoms of the depressive phase are similar to those of unipolar depression except that the person is more lethargic, sleeps more. Depression symptoms can include sad mood, insomnia, weight loss or weight gain, fatigue, agitation, guilt, helplessness, and suicide behavior. In full blown manic psychosis, the mood is elation but with irritability, hostility with a flamboyant nature and a rapid, unstoppable flow of speech. Mania symptoms can include rapid speech, grandiose ideas, irritability, hallucinations, and hearing voices. Mania DIGFAST Symptoms - Distractibility, Insomnia, Grandiosity, Flight of ideas, Agitation, Speech pressured, Taking risks 9 Depressive Symptoms - agitation, atypical depression, feelings of worthlessness, hyperphagia, hypersomnia, melancholia, psychomotor retardation, suicidal ideation, minimal tearfulness |
| diagnosis: | Based on signs, symptoms, history and exam. Occasionally diagnosed as attention deficit disorder in children, and depression otherwise; the diagnose is usually made after several mood swings. DSM-IV-R Criteria: 1. Bipolar 1 - at least one manic or mixed episode 2. Mania - distinct period of abnormal and persistent elevated expansive or irritable mood for > 1 week plus 3-4 DIGFAST symptoms (see above) 3. Depression - 5 or more of the 9 depressive symptoms (see above) |
| treatment: | Although bipolar disorder is likely due to chemical imbalances within the brain, psychological therapy and support is needed in order to help control the illness. To this is often added a mood stabilizing drug, most commonly lithium in order to prevent relapses and improve functioning. Other mood stabilizing drugs include depakote, topamx and carbamazepine (tegretol) which are also antiseizure drugs. Acute episodes of mania is often managed with hospitalization and medication, such as lithium, haldol, ativan and klonopin. Depression phases are often managed with low dose lithium, tricyclic antidepressants, such as Wellbutrin, and MAOI such as Rx tranylcypromine (parnate). Also, SSRI such as Rx fluoxetine (prozac) or Rx sertraline (zoloft) are also prescribed. The tricyclic antidepressants are known to trigger mania episodes. The "highs" or mania are often treated with the antipsychotics such as the Dibenzodiazepine including risperidone (risperdal) or quetiapine (seroquel), as well as abilify, ziprasidone (geodon) and olanzapine (zyprexa). The mood stabilizer drugs can also be added or even replace the antidepression antipsychotic combination, and these include lithium, carbamazepine (tegretol), valproic Acid (depakote), oxcarbazepine (trileptal) and lamotrigine (lamictal). Rapid cycling is often treated with multiple drugs including lithium, depakote, and calcium channel blockers. ECT (electroconvulsive therapy) also called shock treatment is occasionally used with good results. |
| prevention: | None. |
| outcome: | Most untreated patients experience repeated manic and/or depressive episodes during their life. Treated patients might experience episodes but they are less severe and less frequent. The biggest risk of bipolar disorder is violence, against self or against others. |
skynetMD suggests the following:
| if: | If the person would like a depression Internet Resource |
| go to: | Go to American Psychiatric Association www.psych.org/public_info/depres~1.htm |
| if: | If the person would like a mental health Internet Resource |
| go to: | Go to National Alliance for the Mentally Ill www.nami.org |
Last updated 4/20/2009