Bipolar Disorder Discussion Dr Christo du Plessis Psychiatrist 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 psychosis 1y

Symptoms MOOD COGNITION MANIA Elevated Irritable Euphoria Poor concentration Distractable Poor judgement DEPRESSION Depressed Sad Hopeless Guilt Worthless Helpless Decreased pleasure experience Memory impairment Difficult to make decisions

Symptoms THOUGHTS HYPOTHALAMIC BEHAVIOUR MANIA Racing Fast speech Unrealistic beliefs (own abilities, powers, etc.) ↓ insight Increased energy Decreased need for sleep Spending Phone calls Increased sexdrive Substance abuse High risk behaviour Psychosis DEPRESSION Death ideation Suicide ideation Low energy Fatigued Sleep ↑↓ Appetite↑↓ Weight↑↓ Withdrawn Lethargic

INSIGHT

COURSE: CHRONIC NO TREATMENT: TREATMENT: Get worse ↓ 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)

EPIDEMIOLOGY Comorbid disorders: Psychiatric: General Health: Anxiety Substance abuse Impulse control disorders General Health: Obesity Reduced exercising Smoking DM Increased bloodpressure

TREATMENT Diagnosis Psychologist Dr/Psychiatrist Supportgroup Need to make propper diagnosis – correct treatment Be careful: Dx for MA – problems with life insurance Psychologist Help understand diagnosis ID triggers Info to patient / Support Dr/Psychiatrist Treatment ECT Supportgroup Spouse / Family Friends Psychiatric team OT

MEDICATION MOODSTABILISERS Lithium Anticonvulsants Gold standard Needs monitoring SE: Thyroid, kidneys, Nausea, GIT, Obesity Anticonvulsants Valproate (Epilim, Navalpro, Epilizine) Carbamazepine (Tegretol, Degranol) Lamotrigine (Lamictin, Lamitor, Epitec)

MEDICATION ANTIPSYCHOTICS First Generation Second Generation Haloperidal (Serenace) Flupenthixol (Fluanxol) Chlorpromazine (Largactil) Second Generation Quetiapine (Seroquel, Truvalin, Dopaquel) Risperidone (Risperdal, Risperlet) Olanzapine (Zyprexa, Oleans, Prexalon) Aripiprazole (Abilify) Ziprasadone (Geodon)

MEDICATION BENZODIASEPINES Use for short period SE: E.g.: Addiciton Poor concentration Memory loss E.g.: Diasepam (Valium, Pax, Betapam) Clobazam (Urbanol) Loprazolam (Dormonoct) Clonazepam (Rivotril) Alprazolam (Alzam, Xanor, Zopax)

MEDICATION ANTIDEPRESSANTS SSRI SNRI MELATONIN DERATIVE TRICYCLICS Fluoxetine (Prozac, Nuzak, Lorien) Sertraline (Zoloft, Serdep, Serlife, Zertra) Fluvoxamine (Luvox, Faverin) SNRI Duloxetine (Cymbalta, Cymgen, Yelate) Venlafaxine (Effexor, Venlor) MELATONIN DERATIVE Agomelatine (Valdoxane) TRICYCLICS Amitriptyline (Trepilin, Tryptanol) Clomipramine (Anafranil, Clomidep) NDRI Bupropion (Wellbutrin) OTHER Mirtazapine (Remeron, Adco-Mirteron, Beron)

MEDICATION ECT Only in severely resistant manic cases

RECOMMENDATIONS Take responsibility Regular visits Bloodtests Know your medication Monitor SE Don’t run out of medication Plan ahead if you go away Keep a mood diary