Chapter 18Bipolar Mood Disorder

Definition1.Bipolar I disorder # disorder in which at least one manic or

mixed episode has occurred # commonly accompanied by at least 1 MDE

but not required for diagnosis 2. Bipolar II disorder # disorder in which there is at least 1 MDE

and 1 hypomanic episode # no past manic or mixed episodes.Epidemiology2.Prevalence: 0.6- 0.9%; M:F = 1:13.Age of onset: teen to 20s4.Risk factors Slight increase in upper socioeconomic

groups 60-65% of bipolar patients have family

history of major mood disorders

Classifications1. Classifications of bipolar disorder invilves

describing the current or most recent mood episodes as either manic, hypomanic, mixed or depressed

2. The current or most recent episode can be further clasiffied as without psychotic features, with psychotic features, with catatonic features, with postpartum onset, with seasonal pattern, with rapid cycling

Treatment1.Biological: mood stabilizers, anticonvulsants,

antipsychotics, antidepressents, ECT2.Psychological: supportive or psychodynamic

psychotherapy, cognitive or behavioural therapy

3.Social: vocational rehabitation, leave of absence from school/work, drug and EtOH cessation, substitute decision maker for finances, sleep hygiene, social skills training, education for family members.

Course and Prognosis of bipolar disorder1.High suicide rate (15% mortality from suicide)2.Relapsing and remitting course with alternating

manic and depressive episodes; depressive symptoms tend to occur more frequently and last longer than manic episodes

3.May switch rapidly between depression and mania without any period of euthymia in between

4.High recurrence rate for mania – 90% will have a subsequent episode in the next 5 years

5.Rapid cycling subtype: 4 or more mood episodes in 12 months

The End