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BIPOLAR DISORDER
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Symptomatology and diagnosis
Etiopathogenesis
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BIPOLAR DISORDER
Common illness affecting 2% of the world population (5% if one includes spectrum disorders)
Lifetime prevalence – 1%
6th leading cause of medical disability in the developed nations
Bipolar I – equal in males and females
Bipolar II – more in females
HISTORY – TERMS FOR MRCPSYCH
SYMPTOM DIMENSIONS IN
MOOD/PSYCHOSIS
CLASSIFICATION OF MOOD DISORDERS
Bipolar I
Bipolar II
Cyclothymia
Unipolar single episode
Dysthymia
Unipolar recurrent ‘Unipolar’
‘Bipolar’
SYMPTOMATOLOGY - MANIA
Persistently elevated, expansive, or irritable mood, lasting at least 1 week
Three (or more) of the following symptoms (4/9 in ICD)
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
Pressure of speech
flight of ideas or subjective experience that thoughts are racing
distractibility
increase in goal-directed activity or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful
consequences
SYMPTOMATOLOGY – HYPOMANIC EPISODE
Same symptomatology as mania
Duration – 4 days
Change noticeable by others
No significant socio-occupational disturbance
No Hospitalisation
No psychotic symptoms
SYMPTOMATOLOGY – MIXED EPISODE
The criteria are met both for a manic episode and for a major depressive episode
(except for duration) nearly every day during at least a 1-week period.
Socio - occupational deterioration
The symptoms are not due to the direct physiological effects of a substance (e.g., a
drug of abuse, a medication, or other treatment) or a general medical condition
(e.g., hyperthyroidism).
Copyright © 2009 Blackwell Publishing Ltd. Published by Munksgaard International Publishers Ltd. 2
Medicating mood with maintenance in mind: bipolar depression pharmacotherapy. Malhi, Gin; Adams, Danielle; Berk, Michael Bipolar Disorders. 11 Sup 2:55-76, June 2009. DOI: 10.1111/j.1399-5618.2009.00711.x
SYMPTOMATOLOGY - DEPRESSION
ALGORITHM FOR DIAGNOSIS
SUMMARY OF DSM-IV-TR
CLASSIFICATION OF BIPOLAR DISORDERS
* Symptoms do not meet criteria for manic and depressive episodes.
Bipolar features
that do not meet
criteria for any
specific bipolar
disorders
At least 2 years of
numerous periods
of hypomanic and
depressive
symptoms*
One or more
major depressive
episodes
accompanied
by at least one
hypomanic
episode
FEMALE>MALE
One or more
manic or mixed
episodes, usually
accompanied by
major depressive
episodes
MALE=FEMALE
Bipolar Disorder
Not Otherwise
Specified Cyclothymic Bipolar II Bipolar I
First, ed. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Rev.
Washington, DC: American Psychiatric Association; 2000:345-428.