Bipolar Disorder

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Original Editors - Michael Thompson from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Bipolar disorder, also known as manic-depressive illness, is a disorder that deals with the human brain. The brain causes unusual shifts in mood, liveliness, activity levels, and the ability to carry out daily activities. People that suffer from this disease can experience mood swings that occur as few as a couples times throughout a year or up to multiple times within a day.  

[Photo courtesy of Bipolar Disorder Symptoms. Available at http://cureanxiety.com/bipolar-disorder-symptoms.]

Prevalence

The Depression and Bipolar Support Alliance has estimated that close to 6 million Americans are affected by bipolar disorder every year. Bipolar disorder can affect anyone at any age and is found in all races, ethnic groups and social classes with the typical onset being 25 years old. Patients may be diagnosed in their early childhood to as late as the 4th and 5th decades of life. Bipolar disorder is not gender based and can affect men and women equally. Although, studies have shown that women with Bipolar disorder have more depressive and mixed episodes than men with the disorder. More than 66% of people diagnosed with Bipolar disorder have at least one primary family member with the illness.

The incidence of Bipolar disorder in other countries is notable as well. In Australia it is approximately 238,957 people, in the United Kingdom it is approximately 723,248 people, in Germany it is approximately 989,095 people, in Canada it is approximately 390,094 people, in Iran it is approximately 810,038 people and for both India and China it is approximately 12-15 million people.

Characteristics/Clinical Presentation

Symptoms of manic episode include:

Symptoms of depressive episode include:

MOOD CHANGES: o A long period of feeling “high” or an overly happy/outgoing mood o Extremely irritable mood, agitation, feelin “jumpy” or “wired.” BEHAVIOR CHANGES: o Talking very fast, jumping from one idea to another, having racing thoughts o Being easily distracted o Increasing goal-directed activities o Being restless o Sleeping little o Having unrealistic belief in one’s ability o Behaving impulsively and taking part in many pleasurable high-risk behaviors.

MOOD CHANGES: o A long period of feeling worried or empty o Loss of interest in activities once enjoyed BEHAVIORAL CHANGES: o Feeling tired o Having problems concentrating, remembering or making decisions o Being restless or irritable o Change in eating or sleeping o Thinking of death or sudicide or attempting suicide.

• Mood Changes that occurs with Bipolar Disorder:
  File:Bipolar-adults-scale.jpg

Associated Co-morbidities

These co-morbidities range from mental health disease all the way to physical system disorders. "Comorbidity in Bipolar disorder; the complexity of diagnosis and treatment" reports that there are three main mental health co-morbidities associated with Bipolar disorder; anxiety, attention deficit/hyperactivity disorder and substance abuse.

Mental Health Co-Morbidities

• ANXIETY:

Anxiety is define a a feeling of apprehension which results in physical symptoms during certain periods of a person's life. "In the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), lifetime prevalence for a comorbid anxiety disorder affected 51.2% patients with BPD." STEP-BD reports that patient with bipolar disorder are at a higher risk for many different types of anxiety disorder such as simple phobia, social phobia, obsessive-compulsive disorder and most prominent being panic disorder. "Of these, panic disorder appears to have the highest risk of comorbidity."

• ATTENTION DEFICIT/HYPERACTIVITY DISORDER:

Another co-morbiditiy that can be associated with bipolar disorder is attention deficit disorder/hyperactivity disorder which can be characterized as short attention spasm with difficulty sitting in one place for long periods of time or focusing on one task. When ADHD is overlapped with bipolar disorder many people can present with different symptoms than ADHD include irritability, impulsivity, distractibility, overactivity, rapid speech, and emotional lability. These symptoms can be associated with multiple disorders and no good diagnostic tool has been created to true understand the affects of these two disease have on each other.

• SUBSTANCE ABUSE:

"The co-morbiditiy of substance abuse was found to exist in 61% of patients with bipolar disease. Research from the Stanley Foundation Bipolar Network found that the lifetime prevalence rate of alcohol abuse or dependence was 49% for bipolar men and 29% for bipolar women. Women with BPD seemed to be at higher risk for alcoholism than women in the general population." Many different types of substance abuse have been seen in people with bipolar disorder that range from alcohol use to street drugs to prescription narcotics.

Medical Co-morbidities:

Associated medial co-morbidities include but no limited to cardiovascular disease, type two DM, and endocrine disorders

Medications

There are many medications that a physician may prescribe to a patient diagnosed with Bipolar disorder. One of the most popular medications that is prescribed is Lithium. It is a mood stabilizing drug and has been shown to significantly reduce the amount of hospitalizations in patients with Bipolar disorder. It has an effectiveness of up to 80% on all hypomanic and manic episodes. Valproate and Carbamazepine are the first and second most used anti-epileptic medications by many Bipolar disorder patients. These medications work well in treating symptoms such as mania, rapid-cycling and mixed states. Atypical antipsychotics, which are typically used to treat schizophrenia, have been proven to help in the treatment of Bipolar disorder. These include Clozapine, Olanzapine, Risperidone, Quetiapine, Aripiprazole and Ziprasidone. Since patients with Bipolar disorder typically have depression, they will at times be treated with anti-depressants. Although, anti-depressants have been shown to cause mania in 10-30% of patients. Anti-depressants typically prescribed for these patients are Bupropion, Fluoxetine, Citalopram, Sertraline and Proxetine.

Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Differential Diagnosis

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