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BIPOLAR DISORDER

Bipolar is apsychiatric condition with periods of mood swings between elevated mood also called maniac and depressed mood. These differ from the typical mood swings most people experience. Sometimes it also present with psychotic symptoms. When the person is in mania phase, he/she feels euphoric or very irritable.

Types:
  • Bipolar I disorder: Manic episode must be present to make a diagnosis.
  • Bipolar II disorder: No manic episodes, but hypomanic episodes and one or more depressive episodes.
  • Cyclothymic disorder: More than two years of hypomanic episodes with periods of depression,that do not meet criteria for MDD.
  • Substance/medication induced bipolar
  • Medical condition induced bipolar
  • Unspecified bipolar and related disorder
  • Pathophysiology:

    Elevated dopamine levels are responsible for manic phase. Homeostatic down regulation system increases dopamine mediated G protein – coupled receptors. This mechanism decreases dopamine transmission in depressive phase. Homeostatic up regulation brings elevated levels of dopamine. Glutamate levels also increases in manic phase.

    Symptoms:

    Manic Episode: A distinct period of abnormally and persistently elevated, irritable mood and increased energy lasting at least 1 week and present most of the day.

    Also three or more of the following symptoms are present:

  • Inflated self- esteem or grandiosity
  • Decreased need for sleep
  • More talkative
  • Flight of ideas or racing thoughts
  • Distractibility
  • Psychomotor agitation
  • Excessive involvement in activities that have a high potential for painful consequences
  • The mood disturbance is sufficiently severe to cause marked impairment in their functioning or necessitate hospitalization to prevent harm to self or others

    Hypomanic Episode: Same symptoms like above lasting at least 4 consecutive days. But this episode is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization.

    Causes:
  • Genetic and physiological
  • Environmental
  • Neurological and neuroendocrinological
  • Diagnosis:

    Basing on DSM V criteria and mental health evaluation a psychiatrist will make the diagnosis.

    Management:
  • Psychotherapy by cognitive behavioral therapy
  • Medication management: Lithium, Carbamazepine, Lamotrigine, Antipsychotics are some of the medications
  • Alternate therapy: Meditation, nutritional supplements, reiki are couple of supportive paths.