1. Bipolar Disorder Discussion
Dr Christo du Plessis
Psychiatrist
23 May 2014

2. Bipolar Disorder - Definition
Mood disorder
In life:
≥1 manic / hypomanic episode
≥1 depressed episodes

3. Bipolar Disorder - Definition
Characterised by
MOODSWINGS
Impaired functioning

4. Bipolar Disorder - Definition
Types:
Bipolar I
Bipolar II
Mixed episodes
Rapid cycling
Bipolar with psychosis 1y

5. Symptoms MOOD COGNITION MANIA Elevated Irritable Euphoria
Poor concentration
Distractable
Poor judgement
DEPRESSION
Depressed
Sad
Hopeless
Guilt
Worthless
Helpless
Decreased pleasure experience
Memory impairment
Difficult to make decisions

6. Symptoms THOUGHTS HYPOTHALAMIC BEHAVIOUR MANIA Racing Fast speech
Unrealistic beliefs (own abilities, powers, etc.)
↓ insight
Increased energy
Decreased need for sleep
Spending
Phone calls
Increased sexdrive
Substance abuse
High risk behaviour
Psychosis
DEPRESSION
Death ideation
Suicide ideation
Low energy
Fatigued
Sleep ↑↓
Appetite↑↓
Weight↑↓
Withdrawn
Lethargic

7. INSIGHT

8. COURSE: CHRONIC NO TREATMENT: TREATMENT: Get worse
↓ frequency and intensity

9. DIFFERENTIAL DIAGNOSIS
Depression
ADHD
Personality Disorders
Schizophrenia

10. EPIDEMIOLOGY 1-3/100 people Start: 10y 20y 30y 40y 50y Cause: ?
Genetic factors
External stressors
Sleep disturbances (Shiftwork)

11. EPIDEMIOLOGY Comorbid disorders: Psychiatric: General Health: Anxiety
Substance abuse
Impulse control disorders
General Health:
Obesity
Reduced exercising
Smoking DM
Increased bloodpressure

12. TREATMENT Diagnosis Psychologist Dr/Psychiatrist Supportgroup
Need to make propper diagnosis – correct treatment
Be careful: Dx for MA – problems with life insurance
Psychologist
Help understand diagnosis
ID triggers
Info to patient / Support
Dr/Psychiatrist
Treatment
ECT
Supportgroup
Spouse / Family
Friends
Psychiatric team OT

13. MEDICATION MOODSTABILISERS Lithium Anticonvulsants Gold standard
Needs monitoring
SE: Thyroid, kidneys, Nausea, GIT, Obesity
Anticonvulsants
Valproate (Epilim, Navalpro, Epilizine)
Carbamazepine (Tegretol, Degranol)
Lamotrigine (Lamictin, Lamitor, Epitec)

14. MEDICATION ANTIPSYCHOTICS First Generation Second Generation
Haloperidal (Serenace)
Flupenthixol (Fluanxol)
Chlorpromazine (Largactil)
Second Generation
Quetiapine (Seroquel, Truvalin, Dopaquel)
Risperidone (Risperdal, Risperlet)
Olanzapine (Zyprexa, Oleans, Prexalon)
Aripiprazole (Abilify)
Ziprasadone (Geodon)

15. MEDICATION BENZODIASEPINES Use for short period SE: E.g.:
Addiciton
Poor concentration
Memory loss
E.g.:
Diasepam (Valium, Pax, Betapam)
Clobazam (Urbanol)
Loprazolam (Dormonoct)
Clonazepam (Rivotril)
Alprazolam (Alzam, Xanor, Zopax)

16. MEDICATION ANTIDEPRESSANTS SSRI SNRI MELATONIN DERATIVE TRICYCLICS
Fluoxetine (Prozac, Nuzak, Lorien)
Sertraline (Zoloft, Serdep, Serlife, Zertra)
Fluvoxamine (Luvox, Faverin)
SNRI
Duloxetine (Cymbalta, Cymgen, Yelate)
Venlafaxine (Effexor, Venlor)
MELATONIN DERATIVE
Agomelatine (Valdoxane)
TRICYCLICS
Amitriptyline (Trepilin, Tryptanol)
Clomipramine (Anafranil, Clomidep)
NDRI
Bupropion (Wellbutrin)
OTHER
Mirtazapine (Remeron, Adco-Mirteron, Beron)

17. MEDICATION
ECT
Only in severely resistant manic cases

18. RECOMMENDATIONS Take responsibility Regular visits Bloodtests
Know your medication
Monitor SE
Don’t run out of medication
Plan ahead if you go away
Keep a mood diary