2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut1 Bipolar Disorder An Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine
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
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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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, Diagnostic Criteria For Depression
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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
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 Desipramine Hydrochloride Lithium Carbonate
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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.
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.
2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut20 Psychosocial Factors : 1. Life Events & Environmental stress. 2. Family. 3. Premobid personality factors.
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.
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.
2003 August Dar Al-Ajaza Al-Islamia Hospital in Beirut23 Course & Prognosis : Bipolar I Disorder. Bipolar II Disorder.
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
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.
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
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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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
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