ADDITIONAL NOTES

INTRODUCTION
There are two distinct forms of bipolar disorder, which differ in their epidemiology. Bipolar I disorder is
characterized by manic and depressive episodes this is the classic form of the disorder.

Bipolar I disorder is equally common in women and men, while Bipolar II disorder is more common in
women than in men. There is some evidence that women with bipolar disorder may be more prone than
men to depressive episodes.

Bipolar Affective Disorder and The Brain

Three brain chemicals -- noradrenaline (norepinephrine), serotonin, and dopamine -- are involved in
both brain and bodily functions.

What are the causes of Bipolar Affective Disorder?

Neurochemical
As a biological disorder, it may lie dormant and be activated on its own or it may be triggered by
external factors such as psychological stress and social circumstances.

Non drug therapy

Support groups also help people with bipolar disorder. You receive encouragement, learn coping skills,
and share concerns. You may feel less isolated as a result. Family members and friends may also
benefit from a support group. They can gain a better understanding of the illness, share their
concerns, and learn how to best support loved ones with bipolar disorder.
Establish routines. Regular sleep, eating, and activity appear to help people with bipolar disorder
control their moods.
Maintain a regular sleep pattern. Go to bed and wake up around the same times each day. Changes in
sleep can cause chemical changes in the brain, potentially triggering mood episodes.
Do not use alcohol or drugs. These substances can trigger mood episodes. They can also interfere with
the effectiveness of medication.

Drug of choice for Bipolar Affective Disorder

MOOD STABILIZERS: They are the cornerstone of treatment, both for mania and depression.

Lithium salts had been used for a while, as a first-line treatment for bipolar disorder.
The therapeutic effect of lithium salts appears to be entirely due to the lithium ion, Li.

Therapeutic plasma levels of lithium range of 0.51.5 mEq/L, with levels of 0.8 or higher being desirable
in acute mania. Lithium levels should be above 0.6 mEq/L to reduce both manic and depressive episodes
in patients.

Mechanism of action
Its exact mechanism of action is uncertain. Although there are several possibilities
Side effects
Ataxia - dysfunction of the parts of the nervous system that coordinate movement.
Aphasia - language disorders which have in common that they are caused by damage to the brain.

Nondrug therapy
Antipsychotic drugs: Olanzipine and quetiapine: Monotherapy
Vaproic acid anti-manic effect. First choice in acute illness
Antiseizure drugs: carbamazepine and lamotigrine: Acute mania and for prphylaxis in depressive phase.