bipolar disorder

• Bipolar Disorder, also known as Bipolar Affective Disorder and originally called Manic Depressive Illness, is characterized by periods of elevated mood and periods of depression.
• The term used for the bipolar extremes, “melancholy” (depression) and mania, both have their origin in ancient Greek.
• Melancholy derives from “melas” and “chole”.
• Hippocrates thought that depression resulted from an excess of black bile.
• Cognitive Behavioral therapy, family focused therapy, and psycho education have the most evidence for efficacy in regard to relapse prevention.
• Interpersonal and social rhythm therapy and cognitive behavioral therapy appear the most effective in regard to residual depressive symptoms.
• Psychotherapy aims to alleviate core symptoms, recognize episode triggers, reduce negative expressed emotions in relationships, recognize prodromal symptoms before full-blown recurrence, and practice the factors that lead to maintenance of remission.
• Mania is the defining feature of bipolar disorder and can occur with different levels of severity.
• Manic episodes are a distinct period of at least one week of elevated or irritable mood.
• Hypomanic episodes are a milder form of mania defined as at least 4 days of the same criteria as mania.
• Depressive episodes are characterized by persistent feelings of sadness, anxiety, guilt, anger, isolation or hopelessness, disturbance in sleep and appetite, fatigue and loss of interest in usually enjoyable activities, problems concentrating, loneliness, self loathing, apathy or indifference, depersonalization, loss of interest in sexual activity, shyness or social anxiety, irritability, chronic pain.
• Severe bipolar depression with psychotic features is characterized by signs of both mania and depression occurring at the same time.
• Clinical phenomena that often accompany the disorder but are not part of the diagnostic criteria include changes in cognitive progress and abilities, mood abnormalities, full major depressive episodes, and attention deficit hyperactivity disorder.
• The diagnosis of bipolar disorder can be complicated by coexisting psychiatric conditions including obsessive compulsive disorder, substance abuse, eating disorder, attention deficit hyperactivity disorder, social phobia, premenstrual syndrome or panic disorder.
• Frequently inherited with genetic factors accounting for approximately 80% of the cause of the conditions.
• If one parent has bipolar disorder, there is a 10% chance that his/her child will develop the illness.
• If both parents have bipolar disorder, the likelihood of their child developing the illness rises to 40%.
• Abnormalities in the structure and function of certain brain circuits could underlie bipolar disorder.
• Functional MRI findings suggest that abnormal modulation between ventral prefrontal and limbic regions, especially the amygdala, are likely to contribute to poor emotional regulation and mood symptoms.
• Environmental factors such as recent life events and interpersonal relationships contribute to the likelihood of onset and recurrences of bipolar mood episodes and as they do for onset and recurrences of unipolar depression.
• Mitochondria and sodium ATPase pump are believed to cause cyclical periods of poor neuron firing (depression) and hypersensitive neuron firing (Mania).
• Initial assessment for bipolar disorder includes a physical exam by a physician and may involve tests to exclude medical illnesses with medical presentations similar to that of bipolar disorder such as hypothyroidism, hyperthyroidism, metabolic disturbance, a chronic diseases or an infection.
• Bipolar spectrum disorders include Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, Bipolar Disorder not otherwise specified.
• Bipolar I Disorder requires at least one manic episode to make the diagnosis; Depressive episodes are common but are unnecessary for the diagnosis.
• Diagnosis of bipolar disorder often goes unrecognized and is commonly diagnosed during adolescence or early adulthood.
• Prevention of bipolar disorder has focused on stress, which although not a diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness.
• Bipolar Disorder not otherwise specified is a catchall category, diagnosed when the disorder does not fall within a specific subtype; It significantly impairs and adversely affects the quality of life of the patient.
• The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without.
• Repeated findings show that 30 - 50 % of adults diagnosed with bipolar disorder report traumatic /abusive experiences in childhood.
• Diagnosis of bipolar disorder takes into account the self-reported experiences of the symptomatic individual, co-workers, and observable signs of illness and is assessed by other health professionals.
• Hospitalization may be required especially with the manic episodes present in Bipolar I.
• The mean delay in diagnosis of bipolar disorder is 5 - 10 years after symptoms begin.
• Bipolar II Disorder does not require manic episodes but one or more hypomanic episodes and one or more depressive episodes; Hypomanic episodes do not go to the full extremes of mania.
• Rating scales for the screening and evaluation of bipolar disorder are used in the diagnosis of bipolar disorder.
• Cyclothymic Disorder is a history of hypomanic episode with periods of depression that do not meet criteria for major depressive episodes; There is a low grade cycling of mood which appears to the observer as a personality trait and interest with functioning.
• Diagnosis of bipolar disorder is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others.