Bipolar Disorder Discussion

Dr Christo du PlessisPsychiatrist

23 May 2014

Bipolar Disorder - Definition

• Mood disorder• In life:

≥1 manic / hypomanic episode

≥1 depressed episodes

Bipolar Disorder - Definition

• Characterised by – MOODSWINGS

– Impaired functioning

Bipolar Disorder - Definition

• Types:– Bipolar I

– Bipolar II

– Mixed episodes

– Rapid cycling

– Bipolar with psychosis1y

SymptomsMOOD COGNITION

MANIA ElevatedIrritableEuphoria

Poor concentrationDistractablePoor judgement

DEPRESSION DepressedSadHopelessGuiltWorthlessHelplessDecreased pleasure experience

Poor concentrationMemory impairmentDifficult to make decisions

SymptomsTHOUGHTS HYPOTHALAMIC BEHAVIOUR

MANIA RacingFast speechUnrealistic beliefs (own abilities, powers, etc.)↓ insight

Increased energyDecreased need for sleep

SpendingPhone callsIncreased sexdriveSubstance abuseHigh risk behaviourPsychosis

DEPRESSION Death ideationSuicide ideation

Low energyFatiguedSleep ↑↓Appetite↑↓Weight↑↓

WithdrawnLethargic

INSIGHT

COURSE: CHRONIC

• NO TREATMENT:– Get worse

• TREATMENT:– ↓ frequency and intensity

DIFFERENTIAL DIAGNOSIS

• Depression• ADHD• Personality Disorders• Schizophrenia

EPIDEMIOLOGY

• 1-3/100 people• Start:

10y 20y 30y 40y 50y

• Cause:– ?– Genetic factors– External stressors– Sleep disturbances (Shiftwork)

EPIDEMIOLOGYComorbid disorders:•Psychiatric:– Anxiety– Substance abuse– Impulse control disorders

•General Health:– Obesity– Reduced exercising– Smoking– DM– Increased bloodpressure

TREATMENT1. Diagnosis

Need to make propper diagnosis – correct treatmentBe careful: Dx for MA – problems with life insurance

2. PsychologistHelp understand diagnosisID triggersInfo to patient / Support

3. Dr/PsychiatristDiagnosisTreatmentECT

4. SupportgroupSpouse / FamilyFriendsPsychiatric teamOT

MEDICATION

• MOODSTABILISERS1.Lithium

1. Gold standard2. Needs monitoring3. SE: Thyroid, kidneys, Nausea, GIT, Obesity

2.Anticonvulsants1. Valproate (Epilim, Navalpro, Epilizine)2. Carbamazepine (Tegretol, Degranol)3. Lamotrigine (Lamictin, Lamitor, Epitec)

MEDICATION

• ANTIPSYCHOTICS1. First Generation

1. Haloperidal (Serenace)2. Flupenthixol (Fluanxol)3. Chlorpromazine (Largactil)

2. Second Generation1. Quetiapine (Seroquel, Truvalin, Dopaquel)2. Risperidone (Risperdal, Risperlet)3. Olanzapine (Zyprexa, Oleans, Prexalon)4. Aripiprazole (Abilify)5. Ziprasadone (Geodon)

MEDICATION• BENZODIASEPINES1. Use for short period2. SE:

1. Addiciton 2. Poor concentration 3. Memory loss

3. E.g.: Diasepam (Valium, Pax, Betapam)Clobazam (Urbanol)Loprazolam (Dormonoct)Clonazepam (Rivotril)Alprazolam (Alzam, Xanor, Zopax)

MEDICATION• ANTIDEPRESSANTS1. SSRI

1. Fluoxetine (Prozac, Nuzak, Lorien)2. Sertraline (Zoloft, Serdep, Serlife, Zertra)3. Fluvoxamine (Luvox, Faverin)

2. SNRI1. Duloxetine (Cymbalta, Cymgen, Yelate)2. Venlafaxine (Effexor, Venlor)

3. MELATONIN DERATIVE1. Agomelatine (Valdoxane)

4. TRICYCLICS1. Amitriptyline (Trepilin, Tryptanol)2. Clomipramine (Anafranil, Clomidep)

5. NDRI1. Bupropion (Wellbutrin)

6. OTHER1. Mirtazapine (Remeron, Adco-Mirteron, Beron)

MEDICATION• ECT– Only in severely resistant manic cases

RECOMMENDATIONS

1. Take responsibility2. Regular visits3. Bloodtests4. Know your medication5. Monitor SE6. Don’t run out of medication7. Plan ahead if you go away8. Keep a mood diary