Definition:the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood (known as mania, or if lesser if degree – hypomania) with or without one or more depressive episodes these usually are separated by periods of normal mood.
Classification / type of disease:
One or more manic episodes.
A history of hypomanic episodes 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 interferes with functioning.
- Bipolar Disorder NOS (Not Otherwise Specified)
This is a catchall category, diagnosed when the disorder does not fall within a specific subtype. Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.
Epidemiology: lifetime prevalence ~1%
Presenting symptoms / signs:
Mania (hypomania): substantially elevated mood, irritability, excessive spending, pressurised speech, flight of ideas, hypersexuality, no need for sleep, reduced attention/judgement, grandiosity, anxiety delusions, hallucinations…hypomania is of a lesser extent and often just perceived as happiness and generally not a problem.
Depressions: same as clinical unipolar depression – sadness, anxiety, guilt, anger, isolation, hopelessness; disturbances in sleep and appetite; anhedonia, depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, suicidal idealation, psychosis, hallucinations, delusions..
It is possible to have a mixed affective episode – where mania and depression occur simultaneously – this is a dangerous scenario where substance abuse and suicide is a high risk.
Aetiology: genetic, environmental, physiological.
- Psychotherapy: CBT, family therapy, interpersonal therapy, psychoeducation.
- Medication: mood stabalisers = lithium carbonate, lamotrigine, valproate, carbamazepine.
- Mania = chlorpromazine and the atypical antipsychotics quetiapine and olanzapine
- Depression = SSRI
- Requires accurate diagnosis, and good treatment. 1/3 = attempt suicide or complete it.
- 4% of the popn suffer bipolar in their life.