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BIPOLAR DISORDERS

BIPOLAR DISORDERS. Presented by: Chris Miller, 4 th Year Medical Student (USESOM), Psychiatry Rotation For: Dr. D. Martinez. TOPICS COVERED. Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder

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BIPOLAR DISORDERS

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  1. BIPOLAR DISORDERS Presented by: Chris Miller, 4th Year Medical Student (USESOM), Psychiatry Rotation For: Dr. D. Martinez

  2. TOPICS COVERED • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder • The epidemiology, etiology, clinical manifestations, and management of each disorder will also be covered.

  3. BIPOLAR I DISORDER • Most serious of all bipolar disorders • Diagnosed after at least one episode of mania. • Patients also may experience major depressive episodes in the course of their lives. http://www.bipolardisorder-symptoms.net/wp-content/uploads/2010/12/bipolar-disorder-symptoms-3.jpg

  4. DIAGNOSTIC CRITERIA FOR MANIC EPISODES General criteria for a manic episode require a period of elevated, expansive, or irritable mood that lasts 1 week or requires hospitalization. A general medical condition and substance abuse must be ruled out before these symptoms are considered mania.

  5. DIFFERENTIAL DIAGNOSIS OF MANIA • May be induced by: • Antidepressant medications • Psychostimulants • Electroconvulsive therapy • Phototherapy • If the above occurs, the patient is diagnosed with substance-induced mood disorder

  6. EPIDEMIOLOGY OF BIPOLAR I DISORDER • The lifetime prevalence is 0.4% to 1.6% • The ratio of males to females affected is equal • There are no racial variations in incidence

  7. ETIOLOGY OF BIPOLAR I DISORDER • Genetic studies indicate that bipolar I disorder is associated with increased bipolar I, bipolar II, and major depressive episodes in first-degree relatives. • X-linkage has been shown in some studies but is still controversial. • Mania can be precipitated by: • Psychosocial stressors • Sleep/wake cycle changes http://img.thebody.com/legacyAssets/62/93/bipolar.gif

  8. CLINICAL MANIFESTATIONS OF BIPOLAR I DISORDER • Defined by the occurrence of a manic episode • A single manic episode is sufficient enough to meet diagnostic criteria but most patients have recurrent manic episodes mixed with depressive episodes • The 1st episode of mania usually occurs in the early 20s • Lifetime suicide rates range from 10% to 15%

  9. CLINICAL MANIFESTATIONS OF BIPOLAR I DISORDER (CONT.) • Children can also present with bipolar disorder that resembles the adult type but differs according to their age and developmental level. • Very young children may present with uncontrollable giggling. • School-age children may try to teach their grammar class in the presence of their teacher. • Adolescents may present with severe anger outbursts and agitation. • Most children with bipolar disorder have more than one relative with the same condition.

  10. MANAGEMENT OF BIPOLAR I DISORDER • The following medications can be used: • Antipsychotics • Benzodiazepines • Mood stabilizers (valproic acid, lithium) • Combination therapy is more effective than monotherapy • Some atypical antipsychotics such as clozapine, quetiapine, olanzapine, and aripiprazole can be used for maintenance • Electroconvulsive therapy can also be used for refractory cases and patients intolerant to medications.

  11. BIPOLAR II DISORDER • Bipolar II disorder is similar to bipolar I disorder except that mania is absent in bipolar II disorder. • Hypomania is the essential diagnostic finding. • Hypomania is a milder form of elevated mood than mania. http://stahlonline.cambridge.org/content/ep/images/85702c11_fig8.jpg

  12. BIPOLAR II DISORDER http://knowingbipolardisorder.com/wp-content/uploads/2009/01/bipolar-2-288x300.jpg

  13. CLINICAL MANIFESTATIONS OF BIPOLAR II DISORDER • Characterized by the occurrence of hypomania and episodes of major depression in an individual who has never met criteria for mania or a mixed state. • Hypomania is determined by the same symptom complex as mania, but the symptoms are less severe, cause less impairment, and usually do not require hospitalization. • Bipolar II is cyclic • Suicide occurs in 10% to 15% of patients (same as bipolar I)

  14. MANAGEMENT OF BIPOLAR II DISORDER • The treatment is the same as for bipolar I disorder • Hypomanic episodes do not require as aggressive a treatment as mania. http://www.themedicalguru.com/wp-content/uploads/2010/07/medicine_pills.jpg

  15. CYCLOTHYMIC DISORDER • Cyclothymic disorder is a recurrent, chronic, mild form of bipolar disorder in which mood typically oscillates between hypomania and dysthymia. • If a manic episode or depressive episode is experienced, cyclothymic disorder is not diagnosed. http://www.allaboutdepression.com/cyclothymia/images/graphic2.gif

  16. CYCLOTHYMIC DISORDER

  17. CLINICAL MANIFESTATIONS OF CYCLOTHYMIC DISORDER • Cyclothymic disorder is a milder form of bipolar disorder consisting of recurrent mood disturbances between hypomania and dysthymic mood. • A single episode of hypomania is sufficient enough to diagnose cyclothymic disorder, although most individuals also have dysthymic periods. • Cyclothymic disorder is never diagnosed when there is a history of mania, major depressive episode, or mixed episode.

  18. MANAGEMENT OF CYCLOTHYMIC DISORDER • Cyclothymic disorder can be treated with: • Psychotherapy • Mood stabilizers • Antidepressants • Patients with cyclothymic disorder may never seek medical attention for their mood symptoms http://www.cyclothymiasymptoms.com/help/images/7.jpeg

  19. CONCLUSION • Bipolar I disorder • Diagnosed by at least one manic episode and usually experiences depressive episodes • Bipolar II disorder • Hypomania with depressive episodes • Cyclothymic disorder • Cyclic disorder oscillating between hypomania and dysthymia http://www.free-press-release.com/uploads/news/2010/07/18/1279479453_img1.jpg

  20. REFERENCES • Kaplan USMLE STEP 2 CK Lecture Notes 2010, psychiatry section • http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002517/ • http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml • BluePrints Psychiatry, Lippincott Williams and Wilkins, 2009, mood disorders, pg 8 • http://en.wikipedia.org/wiki/Bipolar_disorder

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