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WHAT IS IT?
Bipolar disorder (or manic depression) is a mood disorder that is characterized by alternatig periods of manic/hypomanic and depressive episodes. Bipolar disorder is divided into two different types:
Bipolar 1: characterized by presence of at least 1 manic episode with or without a hypomanic or depressive episode.
Bipolar 2: characterized by presence of a hypomanic and a depressive episode.
Manic episodes are very extreme periods where the patient has an unusually high mood/energy. Fast talking, rushes of ideas, feelings of grandiosity are all hallmarks. Hypomanic episodes are very similar but not quite as severe (and do not impair/debilitate the patient quite as much).
WHY IS IT A PROBLEM?
These behavioral changes greatly affect the day to day functioning of patients, and dramatically increase the risk of self harm/suicide.
WHAT MAKES US SUSPECT IT?
Risk factors: family history, genetic factors, depression
Chief concern: patients often present with symptoms of depression (most common) and mania.
HOW DO WE CONFIRM A DIAGNOSIS?
Bipolar I: Patients will have at least one manic episode (lasting at least 1 week) that includes 3 or more of the DIG FAST criteria:
- Distractibility
- Insomnia
- Grandiosity
- Flight of ideas or racing thoughts
- Activity, Agitation (increased working/sexual activity)
- Speech (pressured or rapid talking)
- Thoughtlessness such as engaging in pleasurable activities with negative consequences (gambling/shopping sprees).
Bipolar II: patients with this condition have NEVER had a manic episode. Instead they have had at least one major depressive episode and at least one hypomanic episode. The hypomanic episode only needs to last 4 days, and while they have the same DIG FAST criteria, the symptoms are less severe.
HOW DO WE TREAT IT?
*Psychosocial treatments are not particularly effective for bipolar disorder
Long term maintenance therapies:
- Lithium: commonly used for bipolar disorder, however the exact mechanism is not well understood. Side effects include: tremor, nephrogenic diabetes insipidus, hypothyroidism, pregnancy problems.
- Valproic acid: anti-seizure medication that increases sodium channel inactivation as well as GABA concentrations (inhibits GABA transaminase).
- Carbamazepine: anti-seizure medication that increases sodium channel inactivation.
Short term therapies (to help treat acute mania):
- Atypical antipsychotics (such as risperidone): The mechanism of these medications is not completely understood but they are thought to modulate dopamine, serotonin, alpha, and H2 receptor signaling.
HOW WELL DO THE PATIENTS DO?
Even with treatment, 37% reported to relapse within 1 year and 60% within 2 years (source)
*This is a lifelong condition that requires lifelong pharmacotherapy
WAS THERE A WAY TO PREVENT IT?
While directe prevention methods are still unclear, the Mood Disorder Questionnaire (MDQ) has been used as a screening tool (but has limited efficiency and will not pick up many cases of bipolar disorder)
With this in mind, Methylphenidate (Ritalin), Cocaine, antidepressant, and corticosteroid usage has been linked to mania.
WHAT ELSE ARE WE WORRIED ABOUT?
Depression: it is very common for patients with bipolar disorder to also suffer from depression.
Suicide: 25-50% of patients with bipolar disorder attempt suicide and 15% are successful (30X greater than general public, source)
Use of antidepressants can precipitate manic episodes.
Valproic acid is a teratogen and can cause birth defects (such as spina bifida)
Carbamazepine: carries a risk of agranulocytosis and increase liver function test results.
OTHER HY FACTS?
Page Updated: 12.14.2015