Week 2- Bipolar disorder

Bipolar disorder

mood disorder characterized by alternating depression and elation, with periods of normal mood in between

Cyclothymic disorder

 type of bipolar disorder characterized by chronic fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms

Flight of ideas

rapidly changing, fragmentary thoughts

Hypomania

 less extreme form of mania that is not severe enough to markedly impair functioning or require hospitalization

Bipolar I

 patients typically experience one or more manic episodes, often accompanied by major depressive episodes

Bipolar II

involves at least one hypomanic episode and major depressive episodes, but no full-blown manic episodes.

Etiology

• age

• may go undiagnosed in absence of maniac episodes

• later diagnosis more severe symptoms

  • greater functional impairment; poor quality of life

• examine hx over time

• early assessment for hx of manic symptoms in a patient w/depression

Risk factors

• family hx of bipolar disorder

  • children of parents w/ bipolar disorder have increased risk

• advise childhood experience (abuse, neglect)

• prenatal viral infections

• substance use or abuse

• women and men at equal risk

  • women more likely to experience rapid cycling, depressive symptoms

  • women more at risk for comorbid alcohol abuse

Mania episode

abnormally elevated, expansive, or irritable mood lasting at least one week or causing hospitalization. 

• Symptoms include rapid, pressured speech, inflated self-esteem, distractibility, impulsivity, and disordered sleep. Patients often exhibit grandiosity, feeling invincible or omnipotent, and may engage in risky behaviors such as reckless spending, unsafe sex, or substance use.

Hypomania episode

milder form, lasting at least four days, not impairing social or occupational functioning, and lacking psychotic symptoms. 

• Patients may feel good, energetic, and more productive, but their behaviors can still be subtly disruptive.

Depressive episode

Symptoms of depression

• Assess for safety

• Administer antidepressant w/ mood stabilizer

Lithium

remains a cornerstone, requiring regular blood level monitoring due to its narrow therapeutic window (0.6-1.2 mEq/L) and high toxicity risk.

• NOT FOR pregnancy, breastfeeding, renal problem, CHF, brain disease, sodium restrictions, thyroid restriction, thyroid disease

Antipsychotics- (e.g., quetiapine, olanzapine)

administered orally or via injectable forms to enhance compliance

Anti-seizure medications- (e.g., valproate, carbamazepine)

often used alone or with lithium, but must be tapered gradually to prevent relapse

Children

may show mood swings, behavioral changes, or grandiosity; diagnosis is cautious due to overlapping developmental behaviors. Treatment includes medications at lowest effective doses and psychotherapy.

Adolescents

experience mood fluctuations; differentiation from normal teenage behavior is critical. Treatment emphasizes medication, psychotherapy, and behavioral interventions.

Pregnant women

medication management challenges due to fetal risks, necessitating close monitoring, dose adjustments, and risk-benefit analysis with healthcare providers.

Older adults

experience late-onset bipolar episodes, often with lower doses due to increased sensitivity and comorbidities like kidney or thyroid disease. Monitoring for toxicity is essential.