1. MOOD DISORDERS 2 Dr Nesif J. Al-Hemiary MBChB - FICMS(Psych) International Associate of the RCPsych.(UK) International Associate of the RCPsych.(UK)

2. Bipolar disorder These disorders include Bipolar I, Bipolar II, and cyclothymia. These disorders include Bipolar I, Bipolar II, and cyclothymia. Bipolar I disorder is a syndrome characterized by a complete set of manic symptoms (manic episodes) occurs during the course of the disorder and major depressive episodes, while in bipolar II disorder hypomanic symptoms occur instead of mania. Bipolar I disorder is a syndrome characterized by a complete set of manic symptoms (manic episodes) occurs during the course of the disorder and major depressive episodes, while in bipolar II disorder hypomanic symptoms occur instead of mania. Cyclothymia is a chronic disorder in which there are episodes of hypomanic symptoms and mild depressive symptoms. Cyclothymia is a chronic disorder in which there are episodes of hypomanic symptoms and mild depressive symptoms.

3. Bipolar I Disorder Bipolar I disorder is less common than major depressive disorder,with a lifetime prevalence of 1% similar to the figure of schizophrenia, while the lifetime prevalence of bipolar II disorder is about 0.5%. Bipolar I disorder is less common than major depressive disorder,with a lifetime prevalence of 1% similar to the figure of schizophrenia, while the lifetime prevalence of bipolar II disorder is about 0.5%. It has an equal prevalence for men and women. It has an equal prevalence for men and women. The onset is generally earlier than that of major depressive disorder. The onset is generally earlier than that of major depressive disorder. The age of onset of BP I disorder ranges from childhood as early as age of 5 or 6 to 50 years or even older,with a mean age of 30 years. The age of onset of BP I disorder ranges from childhood as early as age of 5 or 6 to 50 years or even older,with a mean age of 30 years. It may be more common in divorced and single people than among married people, but the difference may reflect an early onset and the resulting marital discord characteristics of the disorder. It may be more common in divorced and single people than among married people, but the difference may reflect an early onset and the resulting marital discord characteristics of the disorder.

4. Clinical features The bipolar I & II disorders include the occurrence of recurrent episodes of mania (bipolar I) or hypomania (bipolar II) and major depressive episodes. The bipolar I & II disorders include the occurrence of recurrent episodes of mania (bipolar I) or hypomania (bipolar II) and major depressive episodes. The first episode can be any of them. The first episode can be any of them. Manic episode : Manic episode : 1. An elevated,expansive or irritable mood is the hallmark of a manic episode. 2. The elevated mood is euphoric and often infectious. 3. Patients are also disinhibited, and become angry when their freedom is restricted. 4. They feel energetic,sleep only few hours, become hyperactive,hypersexual and spend a lot of money. 5. They may be preoccupied with religious, political, financial,sexual or persecutory ideas that can evolve into complex delusional systems. Hypomanic episode: characterized by symptoms which may be similar to those of mania but they are less severe so that there is an equivocal change of functioning ( no marked impairment of functioning). Hypomanic episode: characterized by symptoms which may be similar to those of mania but they are less severe so that there is an equivocal change of functioning ( no marked impairment of functioning).

5. Course and prognosis The natural history of bipolar I disorder is usually start with depression and is usually a recurring disorder. The natural history of bipolar I disorder is usually start with depression and is usually a recurring disorder. Most patients experience both depressive and manic episodes, although 10-20% experience only manic episodes. Most patients experience both depressive and manic episodes, although 10-20% experience only manic episodes. The manic episodes typically have a rapid onset (hours to days) but may evolve over few weeks. An untreated manic episode lasts about three months; therefore drugs must not be discontinued before that time. The manic episodes typically have a rapid onset (hours to days) but may evolve over few weeks. An untreated manic episode lasts about three months; therefore drugs must not be discontinued before that time. As the disorder progresses,the time between episodes often decreases. As the disorder progresses,the time between episodes often decreases. After about five episodes,however, the inter-episode interval often stabilizes at 6-9 months. After about five episodes,however, the inter-episode interval often stabilizes at 6-9 months. Some patients have rapidly cycling episodes. Some patients have rapidly cycling episodes. Prognosis of patients with bipolar I disorder have a poorer prognosis than do patients with major depressive disorder. About 40-50% may have second episode within two years. Prognosis of patients with bipolar I disorder have a poorer prognosis than do patients with major depressive disorder. About 40-50% may have second episode within two years.

6. Differential diagnosis 1. Schizophrenia. 2. Schizoaffective disorder. 3. Medical disorders. 4. Substance-related mood disorders.

7. Treatment Treatment of bipolar I disorder include: Treatment of bipolar I disorder include: 1. Treatment of the episode whether depressive or manic. 2. Prophylactic treatment if indicated( maintenance) to prevent or decrease the recurrence and severity of the episodes. Treatment of manic episodes: Treatment of manic episodes: drugs used for this purpose include basically mood stabilizing drugs like lithium, carbamazepine, valproate, gabapentin, toperamate, clonazepam and antipsychotic drugs. Treatment should not be stopped before three months to avoid relapse. drugs used for this purpose include basically mood stabilizing drugs like lithium, carbamazepine, valproate, gabapentin, toperamate, clonazepam and antipsychotic drugs. Treatment should not be stopped before three months to avoid relapse. Maintenance treatment: Maintenance treatment: the decision to maintain a patient on lithium or other mood stabilizing drugs is based on the severity of the patient ’ s disorder, the risk of the adverse effects from these drugs and the quality of the patient ’ s support system. the decision to maintain a patient on lithium or other mood stabilizing drugs is based on the severity of the patient ’ s disorder, the risk of the adverse effects from these drugs and the quality of the patient ’ s support system.

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