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

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