Bipolar Disorder

Author: Sakshi Kiran Dhanait

Overview:

Definition: Lifelong mood disorder with manic/hypomanic and depressive episodes. Epidemiology: 0.5%worldwide prevalence.

Impact: Significant disability, suicide risk, functional impairment. Types: Bipolar I, Bipolar II, cyclothymia.

Management: Mood stabilizers, antipsychotics, psychotherapy, long-term collaborative care.

What is Bipolar Disorder?

Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behaviour. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.

Mood episodes are categorized as manic/hypomanic episodes when the predominant mood is intensely happy or irritable, or depressive episodes, when there is an intensely sad mood or the ability to experience joy or pleasure disappears. People with bipolar disorder generally have periods of neutral mood as well. (psychiatry.org)

An estimated 1 in 200 (or 37 million) people live with bipolar disorder worldwide. In 2021, an estimated 37 million people (or 0.5% of the global population), including approximately 34 million adults, were living with bipolar disorder. The condition is primarily observed among working-age people, but also in youth. While the prevalence of bipolar disorder among men and women is approximately equal, available data indicate that women are more often diagnosed. (who.int)

Stigma Regarding Bipolar Disorder

Bipolar disorder is one of the leading causes of disability globally as it can affect many areas of life. People with bipolar disorder may experience

strained relationships, problems at school or work, and difficulties in carrying out daily activities. Having bipolar disorder also increases the risk of suicide and of developing anxiety and substance use disorders.

Stigma can be considered a combination of three problems:

1. lack of knowledge (ignorance and misinformation),

2. negative attitudes (prejudice),

3. rejection or avoidance behaviour’s (discrimination) (Goffman 2003; Henderson et al. 2013).

Types of Bipolar Disorder

• Bipolar Disorder 1:

  People with bipolar I disorder have experienced one or more episodes of mania. Most people with bipolar I will have episodes of both mania and depression, but an episode of depression isn’t necessary for a diagnosis. Duration: At least 7 days About 50% of people experience psychosis during manic episodes

• Bipolar Disorder 2:

  Longer lasting depressive episodes and hypomania, but without full manic episodes. Requires at least one hypomanic episode and one major depressive episode.

Duration : At least 4 days

• Cyclothymia: 

  People with cyclothymic disorder have a chronically unstable mood state. They experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood (euthymic), but these periods last fewer than eight weeks.

• Other specified and unspecified bipolar and related disorders. (neurodivergentinsights.com/mis)

Diagnosis :

• Physical Examination

• Thorough medical history

• Medical Tests

• Mental health Evaluation

To be diagnosed with bipolar disorder, you must have experienced at least one episode of mania or hypomania. Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may be experiencing.

Management of Bipolar Disorder

Even though symptoms often recur, recovery is possible. With appropriate care, people with

bipolar disorder can cope with their symptoms and live meaningful and productive lives. There are a range of effective treatment options, typically a mix of medicines and psychological and psychosocial interventions.

People with bipolar disorder should be treated with respect and dignity and should be meaningfully involved in care choices, including through shared decision-making regarding treatment and care, balancing effectiveness, side-effects and individual preferences.

Therapies specific to disorders:

• Irrespective of Mood :

  • Lithium

  • Electroconvulsive therapy (ECT)

• Mania :

  • Valproate

  • Carbamazepine

  • Antipsychotics

• Acute Mania:

  • Antipsychotics is the drug of choice as it is fast acting and well tolerated.

  • Benzodiazepines in agitated patients and to improve sleep. Given for a short duration.

• Depression

  • Lamotrigine

  • Antidepressants under the cover of Mood stabilisers.

FDA Approved Antipsychotics:

• Quetiapine

• Lumateperone

• Lurasidone

• Cariprazine

• Olanzapine + Fluoxetine

Psychological Management

• Cognitive Behavioural Therapy (CBT)

• Interpersonal Therapy

• Interpersonal Social Rhythm Therapy

• Solution focused Therapy