1. Bipolar Disorder from Diagnosis to Treatment Dr. Levkovitz Shalvata Mental Health Center School of Medicine, Tel Aviv University

3. Lifelong cyclic illness. 1-5% of population. Peak onset 15-30 years. 5-10 year delay in correct diagnosis. Frequent hospitalization. Public Health Significance of Bipolar Disorder

4. Repeated job change/loss:financial disaster. Alcohol/substance abuse. 50% non-adherence to medication. Increase cardiovascular mortality. Suicide. Public Health Significance of Bipolar Disorder (Con`t)

13. Patients with bipolar disorder show:  Attention, concentration and psychomotor speed.  Abstract reasoning and executive control  Verbal fluency  Verbal memory performance.

15. Outcome and Suicide of Bipolar 1 and Bipolar 2 Patients ( Angest et al. Acta Psych. Scandi) Bipolar 1 Bipolar 2 p-Value N16060 Recovered % 1518 Recurrent % 7360 Chronic % 1415 Suicide % 860.005* GAS (last interval) 60650.03*

16. Brain and Bipolar

17. מחקרי הדמיה ב- PET מצביעים על שינויים ממוקדים בזרימת הדם וצריכת הגלוקוז במוח:

18. מחקרי הדמיה ב - PET מצביעים על שינויים ממוקדים בזרימת הדם וצריכת הגלוקוז במוח באפיזודה מאנית.

19. Suseptibility Loci for Bipolar Overlap with vulnerability to schizophrenia?  18p11.2  22q11-13  GRK3. (Berrettini WH. Biological Psychiatry. 2000 Kelsoe et al. Proc. Natl. Sci. USA. 2001).

41. Psychosocial Therapy for Bipolar Disorder  Educate the patient about bipolar disorder.  Foster acceptance of the illness and its treatment.  Encourage medication adherence.  Monitor mood symptoms daily.  Promote daily routines and sleep/wake cycles.

42. Psychosocial Therapy for Bipolar Disorder (Con`t)  Minimise interpersonal oversitmulation, notably significant conflict with caregivers.  Use interpersonal problem-solving.  Learn to spot early warning signs of new episodes.  Develop and implement relapse prevention plans.

43. Prognosis and Complication

44. Drug Adherence Among Bipolar Patients  59% of patients hospitalised for a major affective episode are fully or partially noncompliant in the year following discharge.  Only 21%of patients on lithiume are continuously adherent to it.  Nonadherence is predicted by male gender, younger age, severe illness, substance misuse, and lack of family support.

45. Factors Associated with Unstable Mood  Comorbidity ( Substance abuse, panic disorder, OCD).  Manic or mixed episodes.  Psychosis at index episode.  Typical neuroleptics.  Use of antidepressants?  Psychosocial stressors.  Noncompliance.

46. Morbidity in Bipolar Disorder  Dyslipidemias.  Diabetes Mellitus.  Cardiovascular illnesses.  Substance abuse.  Tobacco dependence  Poor Nutrition.

47. Characteristics of Pharmachological Hypomania/Mania   Less likely with SSRIs vs TCAs ( Peet 1994).   “Milder” than spontaneous episodes?   Euphoric with MAOI vs dysphoric with TCAs ( Himmelhoch et al. 1991)   Not always preventable with mood stabilizers ( Bottlender et al. 1998)   Adequate lithium level may be protective ( Jann et al. 1982)   Not caused by Atypical Antipsychotic ( Baker et al. 2003)

48. Thank You !!!

49. Bipolar Disorder  1-2% of adult population  10-20% of all mood disorders.  Clinical and genetically heterogenous.  40% of all cases go untreated !  15-25% commit suicide.

50. 1998 International Barcelona “Consensus” on Bipolarity/   Bipolar 1   Mixed manic state ( 2 depressive symptoms)   Bipolar 2 ( Hypomania >2 days)   Somatic treatment induced hypo/mania (Bipolar 3)   Cyclothymic disorder (borderline personality).   Recurrent brief hypomania.

51. Symptoms Domains of Bipolar Bipolar Disorder Manic Mood and Behaviour Euphoria Grandiosity Pressure speech Impulsivity Excessive libido Social Intrusiveness Diminished need for sleep Psychotic Symptoms Delusions Hallucinations. Dysphoric or negative Mood and behavior Depression Anxiety Irritability Hostility Violence or Suicide Cognitive Symptoms Racing thoughts Distractibility Disorganization Inattentiveness.