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SKILL 5
DEFINITION

Bipolar disorder is a recurrent chronic disorder

characterised by fluctuations in mood state and energy
Bipolar disorder is a chronic, relapsing illness characterized
by recurrent episodes of manic or depressive symptoms,
with intervening periods that are relatively (but not fully)
symptom-free.
PATHOPHYSIOLOGY

Knowledge of the pathogenesis and pathophysiology of bipolar

disorder has progressed rapidly over the past few decades.
Historically, mood disorders were thought to result from an
imbalance in mono aminergic neurotransmitter systems such
as the serotonergic, noradrenergic, and in particular in
bipolar disorder the dopaminergic neurotransmitter system.
PREVALENCE
Bipolar I disorder  Men = Woman.
Bipolar II disorder  Woman >> Men
Bipolar disorders begin in youth, with a mean age of onset of 20 years
MANIA
- Mania is defined as a distinct period of
abnormally and persistently elevated
expansive or irritable mood and
abnormally and persistently increased
goal-directed activity or energy
- The period lasts ≥1 week and is present
for most of the day, nearly every day
MANIA

• Inflated self-esteem or grandiosity

• Excessive involvement in activities that have high potential for painful
• Increase
• More
• in
Decreased
Flight
Distractibility
talkative
goal-directed
need
of ideas
than
for sleep
usual
activity
consequences
HIPOMANIA
Hypomania is defined as above for mania although with a lower threshold
for symptoms of lower severity
Symptoms do not cause occupational or social impairment
The symptoms are not severe enough to require hospitalization and are not
psychotic in nature
The duration required to meet episode criteria is ≥4 days
Usual functioning
DEPRESSIVE
The symptoms cause clinically significant distress or impairment in social,
occupational or other important areas of functioning, and the episode is
not attributable to the physiological effects of a substance or another
medical condition.
CLASSIFICATION

Bipolar I disorder

Bipolar II disorder
BIPOLAR I DISORDER
- At least one manic episode must be presented, although major
depressive episodes are typical but not needed for diagnosis
BIPOLAR II DISORDER

At least one hypomanic episode and one major

depressive episode are needed for diagnosis
TREATMENT

Pharmacologic treatments for bipolar disorder include the

conventional mood stabilizers (eg, lithium, valproate,
lamotrigine, and carbamazepine) and most of the currently
marketed atypical antipsychotics. SSRI (except paroxetine) and
bupropion may be used as first-line treatments in patients with
bipolar disorder with no history of rapid cycling and without
concomitant manic symptoms, but always in conjunction with a
mood stabilizer or an atypical antipsychotic.
MANAGEMENT
PSYCHOSOCIAL TREATMENT

Psychosocial treatments, including individual

psychotherapies as well as educational and supportive
group therapies, are increasingly considered an integral
part of the treatment of BD
REFERENCES
Jann, Michael W. (2014). Diagnosis and treatment of bipolar disorders in adults: a review of the evidence on pharmacologic treatments. American health &
drug benefits 7.9 489.
Vieta, Berk, Schulze, et al. (2018). Bipolar disorders. Macmillan Publishers Limited, part of Springer Nature. 18008:4.
Jann, Michael W. (2014). Diagnosis and Treatment of Bipolar Disorders in Adults: A Review of the Evidence on Pharmacologic Treatments . Accessed :
April 15th 2019. www.AHDBonline.com