Bipolar Disorder

Bipolar DisorderSpring Hospital, Dr. Muhammad Ismail TariqDr Harim Mohsin

Bipolar disorder awarenessObjectives:

Increase awareness of bipolar disorder (including both mania and depression)Promote early detection and accurate diagnosisReduce StigmaMinimize the Impact on those who live with this medical illness.

Bipolar Disorder-Major Public Health Issue

Costs of treatment for an individual exceed $17,000 per year.

1 in 3 people with bipolar disorder fail to comply with medications.

Non-adherence to treatment often results in hospitalization and suicide

Prevalence Rates and CourseBipolar ILifetime: .4-1.6%= in men and womenMen>manic episodesWomen>dep episodesWomen>rapid cyclingAve. age onset = 20Recurrent 60-70% of manic episodes occur before or after a depressive episode

What is Bipolar Disorder?Bipolar disorder is a serious mental illness that is characterized by extreme mood swings from mania to depression.

Mania is an abnormally elevated mood, while depression is an abnormally low mood.

Severe mania HypomaniaMild depressionSevere depressionMoods Alternate Between Poles

HighLowsNormal Mood

Lets talk about how the moods alternate. Along a continuum there is a high end, middle, and low end that reflects a person with bipolar disorder and their mood. There are two opposite polls at each end reflecting very different moods, this is why it is called bipolar disorder. A person with this disorder can swing from one end to the other. Mania is at the extreme of one poll, with severe depression at the other poll, with normal mood being in the middle. 6

Biological Approach

The biological approach to bipolar disorder suggests that high or low levels of neurotransmitters such as dopamine, serotonin, or norepinephrine is the cause.

Case 1: Shoaib

35 years old male brought forcefully by family. Since a week had not slept, and had been busy writing a novel, getting banners published and building huge projects. His children were afraid of his aggressive behavior and he had recently started using recreational drugs too. He was usually flirting and acting inappropriately with women. He was fired from his job but he said that he didnt need it as he was going to launch his own company soon.

Case 2: Shaista

23 year old female presented with crying spells, no interest in activities, disturbed sleep, decreased appetite, social withdrawal and a suicidal attempt of over-dosing of sleeping pills. Her mother often suffered from the same symptoms and was diagnosed with bipolar disorder.

Famous people with bipolar disorder.

Beethoven Musician.

Abraham LincolinU.S President

Catherine Zeta JonesHollywood Actress

Winston Churchill- British Prime Minister.

Isaac Newton- Scientist

Vincent Van Gogh-Artist

ManiaPersistent abnormally elevated irritable mood

> one week

Mania is defined as an episode that lasts more than a week and consists of an abnormally high mood. Sometimes these are the people who are the loudest in a crowd, the most daring, and confident people. At first they can appear happy, energetic, and animated but they continue with this behavior longer than what is considered the norm. This level of high energy physically and mentally takes a toll on their body depleting them of energy when they eventually come crashing down.12

Symptoms of ManiaInflated self-esteem/grandiosity Decreased need for sleep Racing thoughts or "flight of ideas" Spending sprees Increased physical/mental energy Irritability/aggressive behavior Impulsive/risk taking Increased sexual drive

Mania can be displayed in a variety of symptoms. A manic person will not necessarily have all of these symptoms but most likely a few in a variety of combinations. They can feel they are unstoppable, take risks they usually would not take while finding it difficult to sleep due to racing thoughts. Many times they find it is difficult to relax in one place due to the increased physical and mental energy. They can become overly aggressive or irritable and feel a increase in their sexual drive. Due to their impulsiveness some people feel the need to go on spending sprees buying things they want in the moment. These symptoms can lead to dangerous acts and intervention from family and friends is needed to keep the person safe and get them help. People are less likely to seek treatment when they are in the manic phase because they usually do not realize that anything is wrong and most describe it as a good feeling (NAMI, 2011). 13

DepressionFeeling down

Loss of interest in enjoyable things

> 2 weeks

Depression is the other end of the pole. Major depression is defined as a serious medical illness that affects 15 million American adults in a year (NAMI, 2011). It is more then the blues lasting much longer affecting the daily life of those experiencing it. People with depression lose interest in things they once loved to do and isolate themselves from others. 14

Symptoms of Depression (Cont.) Weight loss/gain Insomnia/hypersomnia Psychomotor agitation/slow down Fatigue/loss of energy Decreased ability to concentrate/make decisions Recurrent thoughts of death/suicide

Like mania there are many symptoms of depression and one does not have to exhibit all of them to be diagnosed as depressed. They may eat too much or not feel like eating at all. Some people have difficulty sleeping and others sleep hours and hours through the night and day rarely leaving their beds. They may feel emotionally and physical tired, sometimes unable to get out of bed at all. Decision making is affected because they cannot concentrate well. Feelings of worthlessness and being a burden to others can bring thought of death and suicide. It is in this mood that people with bipolar disorder are more likely to seek help (NAMI, 2011).15

Hypomania

Mixed stateBetween Mania and Depression

Hypomania is a shorter duration of manic symptoms that are less severe lasting at least four days as is considered a mild functional impairment (Stovall, 2012). People may experience this if they are usually more on the low or depressed side and do not have elated manic symptoms. A mixed state is often referred to as rapid cycling because a person they have both depressive and mania simultaneously. Depressed people are more likely to seek treatment and lays the groundwork for diagnosing bipolar disorder.

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What is it Like to be Bipolar?

People with bipolar disorder are not seeking sympathy, but empathy. In order to understand what it can be like here is a short video than can help explain it. Play video. Now what do you think? What are your thoughts and feelings? What are some ways you could help a friend or loved one with bipolar disorder?17

Etiological FactorsHereditary FactorsBiochemical HypothesisStressful Life EventsFamily environment HEECognitive Styles as Vulnerabilities

Triggerers

B.D. comorbidities & Differential DiagnosisBipolar vs. unipolarADHDSchizophreniaSubstance abuse

Prognostic Indicators of Treatment Outcome

SuicidalityPresence of a personality disorderQuality of family and social supportSubstance useHistory of severity of prior episodesBipolar I type is most severeTreatment onset-the sooner the betterAge of onset-the younger the more severe

Management

Refer to a Psychiatrist Immediately.

Early detection of Individual signature signs.

Ensure the safety of patient and others.Suicidal behaviorHomicidal behaviorRisk taking behavior (financial,sexual,driving etc.)Exhaustion

The Warning Signs of SuicideTalking about death, self-harm, or suicideFeeling hopeless/helpless/worthlessWithdraw from friends/familyActing recklesslyPutting affairs in order or saying goodbyeSeeking out weapons or pills

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How to Help Someone Who is Suicidal

Depression can lead to suicide. Steps should be taken to assure a depressed person gets the help they need. These are some of the ways that you can help someone. Make time for a depressed person or it may be too late. 24

TreatmentMedication- Antipsychotics, Benzodiazepines, Mood stabilizers.

Electroconvulsive therapy.

Psychoeducation for patient and family

Psychological therapy (Interpersonal and social rhythm therapy, CBT & others)

Monitoring and preventionContinually monitor psychiatric status

Identify individuals triggerers

Identify early warnings and seek help

Prevent relapse and encourage adherence to treatment.

Help for care giversMedication-refer to psychiatrist

Take care of own health- seek professional help for own psychiatric issues (e.g depression).

Family, couples therapy, Group therapy

Join a Support group.

Self-Help For Bipolar DisorderMonitor your moodsMake healthy choicesSeek supportKeep stress in checkGet educated

People affected by bipolar disorder can help themselves through keeping track of their moods, making choices that support wellness and managing stress levels. A plan should be in place for support if the need should arise. Seeking education on their own or through support groups about the disorder can help them understand and manage the disorder, realizing that they are not alone.28