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Bipolar Disorder An Update. Presented by Dr Ismail Habli Moderator: Dr Elio Sassine. Definition. Bipolar disorder is a mood disorder which is characterized by manic episodes alternating with major depressive episodes. It is a chronic disorder.
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Bipolar DisorderAn Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine Dar Al-Ajaza Al-Islamia Hospital in Beirut
Definition • Bipolar disorder is a mood disorder which is characterized by manic episodes alternating with major depressive episodes. • It is a chronic disorder Dar Al-Ajaza Al-Islamia Hospital in Beirut
Bipolar I: At least 1 manic or mixed episode, usually with major depressive episodes Bipolar II: At least 1 hypomanic episode with at least 1 major depressive episode; no manic episodes Mixed or rapid cycling: Manic and depressive symptoms occur simultaneously; at least 4 episodes of mood disturbances in prior 12 months Bipolar Disorder Subtypes Dar Al-Ajaza Al-Islamia Hospital in Beirut
Diagnostic Criteria For Depression • Depressed mood +/- loss of interest or pleasure • Change in appetite, weight, sleep • Fatigue/ energy/agitation • Poor concentration; indecisiveness • Feelings of worthlessness/guilt • Suicidal thoughts American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, 1994. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Antidepressant Induction Of Mania • Any antidepressant can trigger switch to mania • More common in bipolar I disorder? Goodwin et al. Arch Gen Psychiatry. 1998;55:23. Sachs et al. J Clin Psychiatry. 1994;55:391. Young et al. Presented at 2nd International Conference on Bipolar Disorder. June, 1997; Pittsburgh, PA. Dar Al-Ajaza Al-Islamia Hospital in Beirut
TCAs Increase FrequencyOf Bipolar Cycles Depression Mania 150 75 Desipramine Hydrochloride Lithium Carbonate 0 50 100 150 200 250 300 Wehr et al. Arch Gen Psychiatry. 1979;36:555. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Etiology : • Biological Factors : • Biogenic Amines , Norepinepherine , Serotonin , Dopamine. • Other Nerochemical Factors: • Neuroendocrine Regulation: • - Adrenal Axis DST Depression. • -Thyroid Axis. • Sleep Abnormalities . • Kindling. • Neuroaimmune Regulation. • Brain imaging. • Neuroanatomical considerations.
Genetic Factors : • Adoption studies. • Twin studies. • Family studies. • Linkage studies : Chr 5 , 11 , x. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Psychosocial Factors : • Life Events & Environmental stress. • Family. • Premobid personality factors. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Specifiers Describing Most Recent Episode: With Psychotic features. With Atypical features. With Catatonic features. Postpartum Onset. Chronic. • Describing course of Recurrent Episodes: Rapid cycling. Seasonal pattern. Longitudinal course specifiers. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Differential Diagnosis : Bipolar I Disorder , Bipolar II Disorder Bipolar III Disorder, cyclothymic disorder, Schizophrenia. Mood Disorders due to a general Medical condition. Substance – induced Mood Disorder. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Course & Prognosis : Bipolar I Disorder. Bipolar II Disorder. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Frequent ComplicationsOf Bipolar Disorder • High suicide rate • Cardiovascular mortality may be increased • Increased affective episodes and hospitalizations • Residual symptoms • Substance abuse • Never married or marital discord/divorce likely • Work impairment/academic underachievement Dar Al-Ajaza Al-Islamia Hospital in Beirut
Treatment : Hospitalization. Pharmaco Therapy : - Lithium. - Anticonvulsants. - Other Agents. - Rapid Cycling. - Maintenance. Psychosocial Therapy. - Cognitive Therapy. - Interpersonal Therapy. - Behavior Therapy. - Psychoanalytically Oriented Therapy. - Family Therapy. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Acute Phase Mood stabilizers (antimanic) Sedative agents: BZD Neuroleptics Antidepressant Maintenance Phase Mood stabilizers Other agents Pharmacological Treatments Dar Al-Ajaza Al-Islamia Hospital in Beirut
Treatment Resistant Bipolar Depression • Limited data for bipolar I depression. • Depression often persists despite mood stabilizer. • SSRIs better tolerated, less likely to trigger mania than TCA & MAOIs. • Consider ECT for severe or delusional bipolar depression. Dar Al-Ajaza Al-Islamia Hospital in Beirut
To Sum Up • Bipolar disorder is a recurring mood disorder with a high morbidity and mortality (suicidal rate15 %). The acute phase (depressive or manic) has a good prognosis with specific treatments, and the disease is preventable and treatable. Dar Al-Ajaza Al-Islamia Hospital in Beirut
Thank you Dar Al-Ajaza Al-Islamia Hospital in Beirut