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