Bipolar I Disorder ( B-I-D)

Def. Characterized by at least one episode of mania & subsequent depression or hypomania or mixed episode. Etiology Biological factors Genetic Neurochemical

Dopamine Norepinephrine Psychosocial factors Manic episodes could be as a defense against underlying depression Life events & environmental stress Epidemiology Life time prevalence of Bipolar I disorder is 0.4-1.6% Bipolar I Disorder prevalence equals in men & women. Common onset is in the teenage years, the 20, or the 30s, Manic episodes predominate in youth & depressive episodes in the later life

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Clinical presentations
A/Depressive episode(Sxs & signs the same as in MDD) B/Hypomanic episode(mild form of mania) C/Manic episode B/Manic episode Clinical presentations: I. Mood disturbances II. Pyschomotor disturbances III. Vegetative disturbances IV. Cognitive distortions I.Mood Disturbances Elation & euphoria associated with laughing & gesturing Low frustration tolerance, which may lead to feelings of anger & hostility. II. Psyhcomotor Disturbances -Movements are faster /hyperactive. -Experiences an unusual sense of physical well being -They are impulsive & disinhibited

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III/ vegetative Disturbance 1. Sleeplessness 2. weight loss 3. hypersexualitey IV/ Cognitive distortions 1.Grandiosity -Inflated self-esteem -Grandiose sense of confidence & achievements -delusion of grandeur 2.Accelerated thinking process - Thinking & perception are unusually sharp - Flight of ideas or subjective experience that thoughts are racing. - Distractibility(i.e,attention too easily withdrawn to unimportant external stimuli) 3. Poor judgment - May engage in activities that harm them & their loved one. e.g., gambling ,having many sexual partners

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Course & prognosis

course : - The first episode could be manic, depressive, or mixed. -Most often starts with depression -Most patients experience both depressive and manic episode. -10-20% patients experience only manic episodes. -5-15% of persons with bipolar I disorder have 4 0r m0re episodes per year(rapid cycler) -Untreated manic episode lasts about 3 months.
Prognosis

On long-term follow up :

- 15% of all patients with B-I-D are well -45% are well but have multiple relapses -30% are in partial remission -10% are chronically ill

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DSM-IV-TR criteria of manic episode

A. Abnormally & persistently elevated,expansive,or irritable mood, last at least 1 week B. During the period of mood disturbance having 3 or more of the following Sxs : 1.Infllated self-esteem or grandiosity 2.Decreased need for sleep 3.More talkative than usual 4.Flight of ideas or subjective experience that are racing 5.Distactibilty 6.Increased in goal directed activity or psychomotor agitation 7.Excessive involvement in pleasurable activities that have a high potential for painful consequences C. Marked functional impairment D. The symptoms are not due to substances, medication, or a GMC

Criteria for mania/hypomania episode

G- grandiosity I- increased activity D- decreased judgment D- distractibility I- irritability N- need for sleep decreased E- elevated mood S- speedy thoughts/flight of ideas S- speedy talk/over talkativeness Hypmanic episode have the same Sxs as manic episode except: -psychotic features -need for hospitalization -sever functional impairment

Differential Diagnosis
-when the patient with B-I-D has a depressive episode, the Ddx is the same as for a Ddx of MDD -When the patient is in manic episode the Ddx includes the following : 1.Bipolar-II-disorder 2.Cyclothymic disorder 3.Mood disorder caused by GMC & Substance-induced mood disorder 4.Schizoaffective disorder 5.Schizophrenia

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Rx I. Pharmacotherapy a. acute b. short term c. long-term 1.Antipsychotics -psychotic feature -short duration of treatment -high- potent 2benzodiazepines(lorazepam,diazepam) 3.Moodstablizers 4.Antidepressants -caution(hypomania, mania) -should be given with Moodstablizer -SSRIs or II. Others 1.ECT 2.psychotherapy