Presentation on theme: "BIPOLAR DISORDERS Presented by:"— Presentation transcript:
1 BIPOLAR DISORDERS Presented by: Chris Miller, 4th Year Medical Student (USESOM), Psychiatry RotationFor: Dr. D. Martinez
2 TOPICS COVERED Bipolar I Disorder Bipolar II Disorder Cyclothymic DisorderThe epidemiology, etiology, clinical manifestations, and management of each disorder will also be covered.
3 BIPOLAR I DISORDER Most serious of all bipolar disorders Diagnosed after at least one episode of mania.Patients also may experience major depressive episodes in the course of their lives.
4 DIAGNOSTIC CRITERIA FOR MANIC EPISODES THREE TO FOUR OF THE FOLLOWING CRITERIA ARE REQUIRED DURING THE ELEVATED MOOD PERIODHighly inflated or grandiose self-esteemDecreased need for sleep, or rested after only a few hours of sleepPressured speechRacing thoughts and flight of ideasEasy distractibility, failure to keep attentionIncreased goal-directed activityHigh excess involvement in pleasurable activities (sex, travel, spending money)General criteria for a manic episode require a period of elevated, expansive, or irritable mood that lasts 1 week or requires hospitalization. A general medical condition and substance abuse must be ruled out before these symptoms are considered mania.
5 DIFFERENTIAL DIAGNOSIS OF MANIA May be induced by:Antidepressant medicationsPsychostimulantsElectroconvulsive therapyPhototherapyIf the above occurs, the patient is diagnosed with substance-induced mood disorder
6 EPIDEMIOLOGY OF BIPOLAR I DISORDER The lifetime prevalence is 0.4% to 1.6%The ratio of males to females affected is equalThere are no racial variations in incidence
7 ETIOLOGY OF BIPOLAR I DISORDER Genetic studies indicate that bipolar I disorder is associated with increased bipolar I, bipolar II, and major depressive episodes in first-degree relatives.X-linkage has been shown in some studies but is still controversial.Mania can be precipitated by:Psychosocial stressorsSleep/wake cycle changes
8 CLINICAL MANIFESTATIONS OF BIPOLAR I DISORDER Defined by the occurrence of a manic episodeA single manic episode is sufficient enough to meet diagnostic criteria but most patients have recurrent manic episodes mixed with depressive episodesThe 1st episode of mania usually occurs in the early 20sLifetime suicide rates range from 10% to 15%
9 CLINICAL MANIFESTATIONS OF BIPOLAR I DISORDER (CONT.) Children can also present with bipolar disorder that resembles the adult type but differs according to their age and developmental level.Very young children may present with uncontrollable giggling.School-age children may try to teach their grammar class in the presence of their teacher.Adolescents may present with severe anger outbursts and agitation.Most children with bipolar disorder have more than one relative with the same condition.
10 MANAGEMENT OF BIPOLAR I DISORDER The following medications can be used:AntipsychoticsBenzodiazepinesMood stabilizers (valproic acid, lithium)Combination therapy is more effective than monotherapySome atypical antipsychotics such as clozapine, quetiapine, olanzapine, and aripiprazole can be used for maintenanceElectroconvulsive therapy can also be used for refractory cases and patients intolerant to medications.
11 BIPOLAR II DISORDERBipolar II disorder is similar to bipolar I disorder except that mania is absent in bipolar II disorder.Hypomania is the essential diagnostic finding.Hypomania is a milder form of elevated mood than mania.
12 BIPOLAR II DISORDER EPIDEMIOLOGY ETIOLOGY The lifetime prevalence of bipolar II disorder is about 0.5%Same factors as bipolar I disorderMore common in women
13 CLINICAL MANIFESTATIONS OF BIPOLAR II DISORDER Characterized by the occurrence of hypomania and episodes of major depression in an individual who has never met criteria for mania or a mixed state.Hypomania is determined by the same symptom complex as mania, but the symptoms are less severe, cause less impairment, and usually do not require hospitalization.Bipolar II is cyclicSuicide occurs in 10% to 15% of patients (same as bipolar I)
14 MANAGEMENT OF BIPOLAR II DISORDER The treatment is the same as for bipolar I disorderHypomanic episodes do not require as aggressive a treatment as mania.
15 CYCLOTHYMIC DISORDERCyclothymic disorder is a recurrent, chronic, mild form of bipolar disorder in which mood typically oscillates between hypomania and dysthymia.If a manic episode or depressive episode is experienced, cyclothymic disorder is not diagnosed.
16 The lifetime prevalence of cyclothymic disorder is 0.4% to 1%. EPIDEMIOLOGYETIOLOGYThe lifetime prevalence of cyclothymic disorder is 0.4% to 1%.Genetic and familial studies reveal an association with other mood disordersThe rate appears equal in men and women, although women are usually more likely to seek treatment
17 CLINICAL MANIFESTATIONS OF CYCLOTHYMIC DISORDER Cyclothymic disorder is a milder form of bipolar disorder consisting of recurrent mood disturbances between hypomania and dysthymic mood.A single episode of hypomania is sufficient enough to diagnose cyclothymic disorder, although most individuals also have dysthymic periods.Cyclothymic disorder is never diagnosed when there is a history of mania, major depressive episode, or mixed episode.
18 MANAGEMENT OF CYCLOTHYMIC DISORDER Cyclothymic disorder can be treated with:PsychotherapyMood stabilizersAntidepressantsPatients with cyclothymic disorder may never seek medical attention for their mood symptoms
19 CONCLUSION Bipolar I disorder Bipolar II disorder Cyclothymic disorder Diagnosed by at least one manic episode and usually experiences depressive episodesBipolar II disorderHypomania with depressive episodesCyclothymic disorderCyclic disorder oscillating between hypomania and dysthymia
20 REFERENCESKaplan USMLE STEP 2 CK Lecture Notes 2010, psychiatry section7/disorder/complete-index.shtmlBluePrints Psychiatry, Lippincott Williams and Wilkins, 2009, mood disorders, pg 8