1. Introduction to bipolar disorder
Domina Petric, MD

2. Bipolar affective disorder (BAD)
It is also called manic-depressive disorder.
BAD occurs in 1-3% of the adult population.
It may begin in childhood, but most cases are first diagnosed in the third and fourth decades of life.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

3. Bipolar affective disorder (BAD)
Depression
Manic phase
depressed mood
diurnal variation
sleep disturbance
anxiety
psychotic symptoms (sometimes)
excitement
hyperactivity
impulsivity
disinhibition
aggresion
diminished need for sleep
psychotic symptoms (some patients)
cognitive impairment
Katzung, Masters, Trevor. Basic and clinical pharmacology.

4. Bipolar affective disorder (BAD)
Mixed manic and depressive symptoms are also seen.
Patients with BAD are at high risk for suicide.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

5. Bipolar affective disorder (BAD)
The sequence, number and intensity of manic and depressive episodes are highly variable.
The cause of the mood swings is unknown: preponderance of catecholamine-related activity may be present.
Drugs that increase this activity tend to exacerbate mania.
Drugs that reduce activity of dopamine or norepinephrine relieve mania.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

6. Bipolar affective disorder (BAD)
Acetylcholine or glutamate may also be involved.
The nature of the abrupt switch from mania to depression experienced by some patients is uncertain.
Bipolar disorder has a strong familial component.
Genetically determined disorder: 8p, 13q.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

7. Bipolar affective disorder (BAD)
Several genes have shown association with BAD with psychotic features and with schizophrenia: dysbindin, DAOA/G30, disrupted inshizophrenia-1 (DISC-1) and neuregulin 1.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

8. Bipolar affective disorder (BAD)
Lithium was the first agent shown to be useful in the treatment of the manic phase.
It has no known use in schizophrenia.
Lithium continues to be used for acute-phase illness as well as for prevention of recurrent manic and depressive episodes.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

9. Bipolar affective disorder (BAD)
Carbamazepine and valproic acid for the treatment of acute mania and for prevention of its recurrence.
Lamotrigine for prevention of its recurrence.
Aripiprazole, chlorpromazine, olanzapine, quetiapine, risperidone and ziprasidone for treatment of the manic phase.
Katzung, Masters, Trevor. Basic and clinical pharmacology.

10. Bipolar affective disorder (BAD)
Olanzapine plus fluoxetine in combination and quetiapine are approved for the treatment of bipolar depression.
Gabapentin, oxcarbazepine and topiramate are sometimes used, but not approved (off label).
Katzung, Masters, Trevor. Basic and clinical pharmacology.

11. Katzung, Masters, Trevor. Basic and clinical pharmacology.
Literature
Katzung, Masters, Trevor. Basic and clinical pharmacology.
Katzung, Masters, Trevor. Basic and clinical pharmacology.