BIPOLAR

DISORDER
Ida Lailatul Hasanah
20172040101089
http://www.free-powerpoint-templates-design.com
Bipolar Disoder
Bipolar disorders are serious, chronic
illnesses characterized by alternating
episodes of mania or hypomania and
depression, or mixtures of manic and
depressive features.

The annual incidence of bipolar

disorders ranges from 3 to 10 cases per
100,000 population, and the lifetime
prevalence is estimated to be 3% to 7%

The public health impact of bipolar

disorders is profound based on well
documented adverse effects on
functioning in nearly all life domains,
including the ability to work
  Early and accurate diagnosis of bipolar disorders is
important for optimizing treatment outcomes.

 Yet, for many patients, the time lag to accurate diagnosis

of BP-I or BP-II is more than 10 years

 No biomarkers with sufficient diagnostic validity for use in

CLINICAL clinical practice are currently available for bipolar

disorders or other psychiatric disorders.

FEATURES
 Therefore, bipolar disorders and other psychiatric illnesses
are diagnosed clinically, and a high index of suspicion
must be maintained.

 Many patients with bipolar disorders are initially diagnosed as having

unipolar major depression, which is problematic because antidepressants
used in the absence of mood stabilizers or selected antipsychotic drugs
may not be effective and can cause a switch to mania or destabilization
of their illness.
Making the Diagnosis

The first step toward the accurate diagnosis of BP-I or BP-II

disorder is identifying current or past manic, hypomanic, and
depressive episodes.

Diagnostic criteria for these types of mood episodes, and

clinical probes for identifying key symptoms

With this information, specific bipolar syndromes can then be

diagnosed, including the classic bipolar disorder subtypes,
BP-I and BP-II, as well as cyclothymic disorder, intermediate
bipolar disorder phenotypes that are commonly encountered in
clinical practice (other specified bipolar and related disorders),
and bipolar disorders due to secondary causes
DIAGNOSTIC
 Onset and
Course
 The peak incidence of BP-I and BP-II
occurs between 12 and 30 years of age

 The symptoms of bipolar disorders are

persistent, particularly depressive
symptoms

 Individuals with bipolar disorders die an

average of 8 to 20 years sooner than
general population controls
.
 Part of this risk can be attributed to suicide,
which occurs 14 times as often in patients
with bipolar disorder compared with the
general population
.
 Unipolar or Bipolar Depression?
A significant challenge is distinguishing between unipolar
and bipolar depression. Episodes of bipolar depression
and unipolar major depression have the same general
Inquiring about past manic or hypomanic diagnostic criteria
episodes is also important for depressed
patients who fail to respond to (or worsen However, a history of manic or hypomanic episodes
during) antidepressant drug treatment distinguishes bipolar depression from unipolar
depression

These characteristics have been shown to increase the

probability of bipolar rather than unipolar major
depression particularly among those with multiple risk
factors. The search for past manic or hypomanic episodes is
especially important for individuals with early onset of their
first depressive episode (<25 years of age), a high lifetime
number of depressive episodes (≥5), a history of psychotic
features during depressive episodes, and a family history
of bipolar disorder.
 CAUSES AND RISK FACTORS
The etiology of bipolar disorders is unknown but is thought to involve widespread abnormalities in

neuroendocrine neurotransmitter intracellular neuronal functioning

signaling systems
that regulate
mood
 Clinical Evaluation
current psychiatric including suicidal ideation, the degree of functional current psychotic features
symptoms intent, or plan impairment ascribable to the and rapid cycling
current psychiatric
symptoms

Evaluation of substance
Interviewing family
abuse, antidepressant use, substance use history and
members and other past manic, mixed,
and corticosteroid treatment past treatment responses
collateral informants is hypomanic, and depressive
preceding hypomanic or (including treatment-
important episodes
manic episodes limitingadverse effects
 Management

Treatment Approach

Treatment generally has 2 phases. Acute-phase treatment is focused on the

management of the acute mood episodes (manic, hypomanic, or depressive).
 Management
Oral or inhaled
In acute treatment settings, patients with bipolar
01 Acute Behavioral Emergencies
disorders may present with severe agitation,
violent behaviors, and psychosis
pharmacotherapy with
benzodiazepines or
antipsychotic drugs

Stabilization of manic symptoms Combining a mood

and dangerous behaviors, Nearly all antipsychotic stabilizer (such as lithium or

02 Acute Manic or Hypomanic

Episodes
restoration of sleep, and, often,
concurrent management of
drugs and mood stabilizers
are effective for treating
manic episodes
valproate) with
antipsychotic drug is more
rapidly effective
an

than
Manic Episodes withdrawal from drugs and alcohol
monotherapy with either

The goal of acute treatment for bipolar depressive

03 Acute Bipolar Depressive
Episodes
episodes is remission.
 Monotherapy with quetiapine or lurasidone and
04 Bipolar-I Depression
A
combination pharmacotherapy with lithium and
lamotrigine, and either quetiapine or lurasidone
plus a mood stabilizer (lithium or valproate)

There is empirical support for quetiapine

05 Bipolar- II Depression
A
monotherapy for BP-II depression
Maintenance Pharmacotherapy
Do you need
an online
doctor now? Treatments that were effective during the acute phase of treatment should
be continued in an effort to prevent early relapses.

Most mood stabilizers and atypical antipsychotics are effective for

preventing manic episodes.

Lithium, lamotrigine, quetiapine, and olanzapine are also efficacious in the

prevention of depressive episodes, although lithium is generally more
effective at preventing manic episodes than depressive episodes, and
lamotrigine is more effective at preventing depressive episodes than manic
episodes.

The use of long-acting injectable atypical antipsychotic drugs such as

risperidone may be helpful for patients with frequent relapses owing to
poor treatment adherence
Thank You