Psychiatry >
Bipolar Disorder
“A disorder consisting of episodes of mania (extremely elated mood or irritability) and extremely depressed mood – long-term illness course characterised by predominance of depression, but at least one manic, hypomanic or mixed episode is needed to make the diagnosis”
Risk Factors
- Family history of bipolar disorder
- Stressful life events
- Previous history of depression
- Physical illness
- Sleep disturbances
Aetiology
- The exact cause of bipolar disorder is unknown but is thought to be due to a combination of biological, psychological and social factors
Pathophysiology
- Proposed theory – reduced responsiveness in areas of the brain associated with cognitive control and increased responsiveness in areas of the brain associated with emotional regulation
Clinical Presentation
- Decreased need for sleep
- Talkativeness
- Distractibility
- Racing thoughts
- Increase in goal-directed activity
- Increased sense of self (grandiosity)
- Excessively seeking pleasurable activities without considering consequences
Investigations
- Diagnosis made based on interviews with patient/family, along with information gained from questionnaires such as the patient health questionnaire and mood disorder questionnaire
Management
- Psychological intervention – eg CBT/interventions designed specifically for bipolar disorder
- Pharmacological interventions
- Treated pharmacologically with a combination of antipsychotics/antidepressants depending on the specific features of the individual.
- Long term pharmacological interventions
- First line = lithium (add valproate if lithium ineffective)
- Valproate/Olanzapine – if lithium poorly tolerated
Complications
- If left untreated, bipolar disorder can lead to various issues including relationship damage, poor performance at work, financial/legal issues or drug/alcohol abuse