1. BIPOLAR DISORDER DR GIAN LIPPI CONSULTANT PSYCHIATRIST
UNIVERSITY OF PRETORIA & WESKOPPIES HOSPITAL
FORENSIC UNIT

2. CONTENTS SYMPTOMS & EPISODES DSM-IV-TR CRITERIA FOR EPISODES SUBTYPES
DSM-IV-TR CRITERIA FOR DIAGNOSIS & SPECIFIERS
BIPOLAR DEPRESSION (vs UNIPOLAR DEPRESSION)
EPIDEMIOLOGY
AETIOLOGY

3. SYMPTOMS & EPISODES DEPRESSIVE EPISODES MANIC EPISODES
- SAME CRITERIA & SYMPTOMS AS A MAJOR DEPRESSIVE EPISODE
MANIC EPISODES
- DISTINCT PERIODS OF ABNORMALLY & PERSISTENTLY ELEVATED, EXPANSIVE OR
IRRITABLE MOOD FOR AT LEAST 1 WEEK (OR LESS IF HOSPITALIZATION IS NEEDED)
- INFLATED SELF – ESTEEM / GRANDIOSITY
- DECREASED NEED FOR SLEEP
- MORE TALKATIVE THAN USUAL / PRESSURED SPEECH
- PRESSURE OF THOUGHT / FLIGHT OF IDEAS
- DISTRACTIBILITY
- INCREASED GOAL – DIRECTED ACTIVITY / PSYCHOMOTOR AGITATION
- EXCESSIVE INVOLVEMENT IN PLEASURABLE ACTIVITIES WITH HIGH POTENTIAL
FOR PAINFUL CONSEQUENCES
HYPOMANIC EPISODES
- DISTINCT PERIODS OF ABNORMALLY & PERSISTENTLY ELEVATED, EXPANSIVE OR
IRRITABLE MOOD FOR AT LEAST 4 DAYS, CLEARLY DIFFERENT FROM THE NORMAL
NON – DEPRESSED MOOD
- SAME SYMPTOMS AS MANIC EPISODES BUT TO A LESSER DEGREE
- CHANGE IN MOOD & FUNCTIONING IS UNCHARACTERISTIC OF THE PERSON &
THOUGH SLIGHT, IS OBSERVABLE BY OTHERS
- NO PSYCHOTIC SYMPTOMS, NO HOSPITALIZATION NEEDED
MIXED EPISODES
- THE CRITERIA FOR BOTH A MAJOR DEPRESSIVE & A MANIC EPISODE
ARE MET OVER A 1 WEEK PERIOD (PRESENT AT THE SAME TIME)

4. DSM-IV-TR CRITERIA, EPISODES

5. DSM-IV-TR CRITERIA, EPISODES

6. SUBTYPES BIPOLAR I DISORDER BIPOLAR II DISORDER
- MANIC EPISODES WITH / WITHOUT MAJOR DEPRESSIVE EPISODES
- MIXED EPISODES
- HYPOMANIC EPISODES IF THERE HAS BEEN A PREVIOUS MANIC / MIXED EPISODE
BIPOLAR II DISORDER
- HYPOMANIC & MAJOR DEPRESSIVE EPISODES
BIPOLAR DISORDER NOT OTHERWISE SPECIFIED
- CLINICAL PICTURE IS OF A BIPOLAR DISORDER BUT SPECIFIC DSM-IV-TR CRITERIA
FOR A BIPOLAR SUBTYPE IS NOT MET, EG:
- VERY SHORT MANIC / MAJOR DEPRESSIVE EPISODES THAT DON’T MEET
THE MINIMUM DURATION CRITERIA
- RECURRENT HYPOMANIC BUT NO MAJOR DEPRESSIVE EPISODES
- UNCERTAINTY AS TO WHETHER THE BIPOLAR DISORDER IS
PRIMARY OR DUE TO A SUBSTANCE / GENERAL MEDICAL
CONDITION

7. DSM-IV-TR DIAGNOSIS & SPECIFIERS
DSM-IV-TR DIAGNOSIS OF BIPOLAR I DISORDER REQUIRES SPECIFYING THE CURRENT / MOST RECENT EPISODE, EACH OF WHICH HAS IT’S OWN DIAGNOSTIC CRITERIA:
- SINGLE MANIC EPISODE
- MOST RECENT EPISODE MANIC
- MOST RECENT EPISODE HYPOMANIC
- MOST RECENT EPISODE DEPRESSED
- MOST RECENT EPISODE MIXED
- MOST RECENT EPISODE UNSPECIFIED
DSM-IV-TR DIAGNOSIS OF BOTH BIPOLAR I & II DISORDERS REQUIRES, ACCORDING TO THE SPECIFIC EPISODE, SPECIFYING THE FOLLOWING, EACH OF WHICH HAS IT’S OWN DIAGNOSTIC CRITERIA:

8. DSM-IV-TR DIAGNOSIS & SPECIFIERS
SEVERITY OF THE EPISODE
- MILD
- MODERATE
- SEVERE WITHOUT PSYCHOTIC FEATURES
- SEVERE WITH PSYCHOTIC FEATURES
ADDITIONAL FEATURES OF THE EPISODE
- WITH CATATONIC FEATURES
- WITH MELANCHOLIC FEATURES
- WITH ATYPICAL FEATURES
ONSET OF THE EPISODE
- WITH POST PARTUM ONSET
COURSE OF THE DISORDER / EPISODE
- IN PARTIAL REMISSION
- IN FULL REMISSION
- CHRONIC
- LONGITUDINAL COURSE WITH INTEREPISODE RECOVERY
- LONGITUDINAL COURSE WITHOUT INTEREPISODE RECOVERY
- WITH SEASONAL PATTERN
- WITH RAPID CYCLING

9. BIPOLAR DEPRESSION
VAST MAJORITY OF TOTAL & 1ST EPISODES ARE DEPRESSIVE
CLUES THAT A DEPRESSIVE EPISODE / 1ST EPISODE MIGHT BE BIPOLAR & NOT UNIPOLAR
- EARLY AGE OF SYMPTOM ONSET
- PSYCHOTIC DEPRESSION BEFORE AGE 25
- POSTPARTUM DEPRESSION, ESPECIALLY WITH PSYCHOTIC FEATURES
- SHORT EPISODES WITH RAPID ONSET & OFFSET
- RECURRENT, MULTIPLE EPISODES
- SEASONAL PATTERN
- EPISODES WITH MARKED PSYCHOMOTOR ABNORMALITIES
(RETARDATION / AGITATION)
- ATYPICAL FEATURES
- FAMILY HISTORY OF BIPOLAR
- HYPERTHYMIC TEMPERAMENT
- HYPOMANIA ASSOCIATED WITH ANTIDEPRESSANT TREATMENT
- RAPID IMPROVEMENT ON ANTIDEPRESSANT TREATMENT
- ANTIDEPRESSANT “POOP OUT” (REPEATED LOSS OF EFFICACY OF
ANTIDEPRESSANT AFTER INITIAL RESPONSE)
- SEVERE ANXIETY

10. EPIDEMIOLOGY LIFETIME PREVALENCE GENDER DIFFERENCES AGE OF ONSET
- BIPOLAR I – 2,4%
- BIPOLAR II – 4,8%
GENDER DIFFERENCES
- BIPOLAR I – EQUAL INCIDENCE, MEN MORE MANIC EPISODES, WOMEN MORE
DEPRESSIVE & MIXED EPISODES
- BIPOLAR II - MORE COMMON IN WOMEN
- RAPID CYCLING MORE COMMON IN WOMEN
AGE OF ONSET
- EARLIER THAN MAJOR DEPRESSIVE DISORDER
- MEAN AGE OF ONSET 30 YEARS (RANGE 5 – 50)
MORE COMMON IN SINGLE / DIVORCED PERSONS

11. AETIOLOGY MULTIFACTORIAL BIOLOGICAL FACTORS GENETIC FACTORS
- DISTURBANCES IN REGULATION OF SEROTONIN, NORADRENALIN, DOPAMINE
- SECONDARY DISTURBANCES IN REGULATION OF OTHER NEUROTRANSMITTERS
- SECOND MESSENGER & INTRACELLULAR CASCADE DISTURBANCES
- ALTERATIONS OF HORMONAL REGULATION
- ALTERATIONS OF SLEEP NEUROPHYSIOLOGY
- IMMUNOLOGICAL DISTURBANCE
- STRUCTURAL & FUNCTIONAL BRAIN ABNORMALITIES
GENETIC FACTORS
- MOOD DISORDERS ARE HEREDITARY
PSYCHOSOCIAL FACTORS
- LIFE EVENTS & ENVIRONMENTAL STRESS
- PERSONALITY FACTORS

12. THE END