diease

Bipolar Disorder


OVERVIEW OF Bipolar Disorder :

Disease overview:

Bipolar disorder is also known as manic depression that brings alternative low and high mood resulting in loss of energy.althernation in the thinking process and behavioural patterns.biploar disorder can interrupt a person’s realationship with their loved ones.

The types of the bipolar disorder includes:

Bipolar disorder 1

Bipolar disorder 2

Cyclothymic disorder

Bipolar disorder  1:

The people with bipolar disoders tends to exhibit elvated irritability. some people also experience depressive and hypomanic attacks.This people tends to  show suicidal attacks

Bipolar disorder 2:

They requires  depressive  episodes or hypomanic People return to their usual functioning between episodes. People with bipolar II disorder often first seek treatment as a result of their first depressive episode, since hypomanic episodes often feel pleasurable and can even increase performance at work or school.

People with bipolar II disorder frequently have other mental illnesses such as an anxiety disorder or substance use disorder, the latter of which can exacerbate symptoms of depression or hypomania.

Cyclothymic disorder:

It is a mild form of bipolar disorder which requires alternative moods of manic episodes and depressive episodes.They experience emotional ups and downs with less severe symptoms.

Cyclothymic disorder symptoms include the following:

  • For at least two years, many periods of hypomanic and depressive symptoms, but the symptoms do not meet the criteria for hypomanic or depressive episode.
  • During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.


EPIDEMIOLOGY :

It affects people with 10-20% of people with mental stress


CAUSES :

Genetic

Environmental factors:

Stress

 Sleep disruption

Drugs

Alcohol

 Trigger mood episodes

Alteration in the brain function and anatomy

Drugs:

  • Sympathomimetics (eg.amphetamine,cocaine)
  • Alcohol
  • Certain antidepressants (eg:tricyclics,monoamine oxidase inhibitors[MAOIS]

    Alteration in the brain function and anatomy

     


PATHOPHYSIOLOGY :

Mutation of mitochondria related nuclear genes and accumulation of mDNA deletions

Impaired mitochondrial ca2+ regulation

Impaired resilience and cellular vulnerability

mtDNA mutations imbalance in the cholinergic and anticholinergic and ionistol


COMMON CLINICAL SIGNS AND SYMPTOMS :

Manic episodes:

This shown the alternative episodes of mood

       Behavioural changes:

  • Sleep depriveness
  • Increased speech
  • Uncontrollable racing thoughts or quickly changing ideas or topics when speaking
  • Easily gets distracted
  • Restlessness on working
  • Delusions and hallucinations as a psychotic behaviour.

        Hypomanic episodes:

This attacks tends to appear only 4 times a week.this does not cause any serious illness.Major depressive episodes:

A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including at least one of the first two symptoms):

  • sadness
  • loss of interest in their favourite activities
  • Feelings of worthlessness or guilt
  • Fatigue
  • Restlessness
  • Difficulty concentrating
  • Frequent thoughts of death or suicide


DIAGNOSTIC :

Physical exam: Your doctors may advice physical examination in which they do the physical exam and lab test to ruleout the disease.

     Psychiatric assessment:

   (e.g., pacing) or slowed speech or movement  A psychiatrist do assessment in with your speech and other behaviours.

  Mood charting:the psychiatrist might assess your moods and other alternation of emotional               attacks.

Criteria for bipolar disorder:

criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

 

  • DSM-5 criteria:

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

    1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
    2.  Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions.
    3. For older adolescents and adults (age 17 and older), at least five symptoms are required.
    4. a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
    5. b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
    6.  c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
    7. d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
    8.  e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
    9.  f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
    10.  g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
    11.  h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
    12.  . Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
    13.  Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a. Often fidgets with or taps hands or feet or squirms in seat.
    14.  Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place.`
    15. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
    16.  Often unable to play or engage in leisure activities quietly. e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
    17.  Often talks excessively. g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
    18.  Often has difficulty waiting his or her turn (e.g., while waiting in line). i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
    19. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
    20. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
    21. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
    22.  The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).


TREATMENT AND PROGNOSIS :

Medications:

The therapy and medication includes the following.

Medications may include:

  • MOOD STABILIZER:
  • it includes lamotreigne,valproiec acid,carbamazepine,lithium,divalproex sodium.

Antipsychotic:

 antipsychotic drug such as olanzepine,risperidone,quetiapine,ziprasidone,lurasidone or asenapine,aripiprazole might help.

Antidepressants: clomipramine,duloxetine,venlafaxine,fluoxetine.these drugs prevents depression and also aids in manic episodes.

Antianxiety medications:benzodiazepines helps to relieve anxiety disorders.

Psychotherapy:

Interpersonal and social rhythm therapy:it helps in mood management.

Cognitive behavioural therapy:

it includes the stress management of the patient and also relieve them from their anxiety.This therapy also focuses on the patient’s emotional disturbances.

Electroconvulsive therapy:

This includes electric shock therapy which prevents the patient from severe attacks and suicidal thoughts.it also treat short term episodes of manic or depressive behaviour.


PROGNOSIS :

The prognosis purely depends upon the mental status of the patient.


PREVENTION :

Pay attention to the warning signs.

Avoid usage of drugs and alcohol

Take the medications properly and follow up the treatments properly

Avoid suicidal thoughts by talking the problems with the family and friends

Take stress managemnet such as practising yoga and meditation.

 


Medicines used in the Treatment :

lamotreigne,

valproiec acid,

carbamazepine

,lithium,

divalproex sodium.

olanzepine,risperidone,quetiapine,ziprasidone,lurasidone or asenapine,aripiprazole  clomipramine,duloxetine,venlafaxine,fluoxetine.these drugs prevents depression and also aids in manic episodes.

benzodiazepines helps to relieve anxiety disorder


REFERENCE :

www.medicinenet.net

http://cdc.in

http://healthline.net

http://psychiatric.org

http://nami.org