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2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut1 Bipolar Disorder An Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine.

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Presentation on theme: "2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut1 Bipolar Disorder An Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine."— Presentation transcript:

1 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut1 Bipolar Disorder An Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine

2 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut2 Definition  Bipolar disorder is a mood disorder which is characterized by manic episodes alternating with major depressive episodes.  It is a chronic disorder

3 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut3  Bipolar I: At least 1 manic or mixed episode, usually with major depressive episodes  Bipolar II: At least 1 hypomanic episode with at least 1 major depressive episode; no manic episodes  Mixed or rapid cycling: Manic and depressive symptoms occur simultaneously; at least 4 episodes of mood disturbances in prior 12 months Bipolar Disorder Subtypes

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8 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut8  Depressed mood +/- loss of interest or pleasure  Change in appetite, weight, sleep  Fatigue/  energy/agitation  Poor concentration; indecisiveness  Feelings of worthlessness/guilt  Suicidal thoughts American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, 1994. Diagnostic Criteria For Depression

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14 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut14  Any antidepressant can trigger switch to mania  More common in bipolar I disorder? Goodwin et al. Arch Gen Psychiatry. 1998;55:23. Sachs et al. J Clin Psychiatry. 1994;55:391. Young et al. Presented at 2nd International Conference on Bipolar Disorder. June, 1997; Pittsburgh, PA. Antidepressant Induction Of Mania

15 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut15 TCAs Increase Frequency Of Bipolar Cycles Wehr et al. Arch Gen Psychiatry. 1979;36:555. Depression Mania 150 75 150 75 Desipramine Hydrochloride Lithium Carbonate 050100150200250300

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18 Etiology : Biological Factors : Biogenic Amines, Norepinepherine, Serotonin, Dopamine. Other Nerochemical Factors: Neuroendocrine Regulation: - Adrenal Axis DST Depression. -Thyroid Axis. Sleep Abnormalities. Kindling.  Neuroaimmune Regulation. Brain imaging. Neuroanatomical considerations.

19 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut19  Genetic Factors : 1. Adoption studies. 2. Twin studies. 3. Family studies. 4. Linkage studies : Chr 5, 11, x.

20 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut20  Psychosocial Factors : 1. Life Events & Environmental stress. 2. Family. 3. Premobid personality factors.

21 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut21  Specifiers Describing Most Recent Episode: With Psychotic features. With Atypical features. With Catatonic features. Postpartum Onset. Chronic.  Describing course of Recurrent Episodes: Rapid cycling. Seasonal pattern. Longitudinal course specifiers.

22 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut22  Differential Diagnosis : Bipolar I Disorder, Bipolar II Disorder Bipolar III Disorder, cyclothymic disorder, Schizophrenia. Mood Disorders due to a general Medical condition. Substance – induced Mood Disorder.

23 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut23  Course & Prognosis : Bipolar I Disorder. Bipolar II Disorder.

24 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut24  High suicide rate  Cardiovascular mortality may be increased  Increased affective episodes and hospitalizations  Residual symptoms  Substance abuse  Never married or marital discord/divorce likely  Work impairment/academic underachievement Frequent Complications Of Bipolar Disorder

25 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut25  Treatment : Hospitalization. Pharmaco Therapy : - Lithium. - Anticonvulsants. - Other Agents. - Rapid Cycling. - Maintenance. Psychosocial Therapy. - Cognitive Therapy. - Interpersonal Therapy. - Behavior Therapy. - Psychoanalytically Oriented Therapy. - Family Therapy.

26 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut26 Pharmacological Treatments  Acute Phase Mood stabilizers (antimanic) Mood stabilizers (antimanic) Sedative agents: Sedative agents: oBZD oNeuroleptics Antidepressant Antidepressant  Maintenance Phase Mood stabilizers Other agents

27 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut27  Limited data for bipolar I depression.  Depression often persists despite mood stabilizer.  SSRIs better tolerated, less likely to trigger mania than TCA & MAOIs.  Consider ECT for severe or delusional bipolar depression. Treatment Resistant Bipolar Depression

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40 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut40  Bipolar disorder is a recurring mood disorder with a high morbidity and mortality (suicidal rate15 %). The acute phase (depressive or manic) has a good prognosis with specific treatments, and the disease is preventable and treatable. To Sum Up

41 2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut41 Thank you

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