1 / 41

Bipolar Disorder An Update

Bipolar Disorder An Update. Presented by Dr Ismail Habli Moderator: Dr Elio Sassine. Definition. Bipolar disorder is a mood disorder which is characterized by manic episodes alternating with major depressive episodes. It is a chronic disorder.

svein
Télécharger la présentation

Bipolar Disorder An Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bipolar DisorderAn Update Presented by Dr Ismail Habli Moderator: Dr Elio Sassine Dar Al-Ajaza Al-Islamia Hospital in Beirut

  2. Definition • Bipolar disorder is a mood disorder which is characterized by manic episodes alternating with major depressive episodes. • It is a chronic disorder Dar Al-Ajaza Al-Islamia Hospital in Beirut

  3. Bipolar I: At least 1 manic or mixed episode, usually with major depressive episodes Bipolar II: At least 1 hypomanic episode with at least 1 major depressive episode; no manic episodes Mixed or rapid cycling: Manic and depressive symptoms occur simultaneously; at least 4 episodes of mood disturbances in prior 12 months Bipolar Disorder Subtypes Dar Al-Ajaza Al-Islamia Hospital in Beirut

  4. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  5. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  6. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  7. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  8. Diagnostic Criteria For Depression • Depressed mood +/- loss of interest or pleasure • Change in appetite, weight, sleep • Fatigue/  energy/agitation • Poor concentration; indecisiveness • Feelings of worthlessness/guilt • Suicidal thoughts American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC, American Psychiatric Association, 1994. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  9. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  10. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  11. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  12. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  13. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  14. Antidepressant Induction Of Mania • Any antidepressant can trigger switch to mania • More common in bipolar I disorder? Goodwin et al. Arch Gen Psychiatry. 1998;55:23. Sachs et al. J Clin Psychiatry. 1994;55:391. Young et al. Presented at 2nd International Conference on Bipolar Disorder. June, 1997; Pittsburgh, PA. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  15. TCAs Increase FrequencyOf Bipolar Cycles Depression Mania 150 75 Desipramine Hydrochloride Lithium Carbonate 0 50 100 150 200 250 300 Wehr et al. Arch Gen Psychiatry. 1979;36:555. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  16. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  17. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  18. Etiology : • Biological Factors : • Biogenic Amines , Norepinepherine , Serotonin , Dopamine. • Other Nerochemical Factors: • Neuroendocrine Regulation: • - Adrenal Axis DST Depression. • -Thyroid Axis. • Sleep Abnormalities . • Kindling. • Neuroaimmune Regulation. • Brain imaging. • Neuroanatomical considerations.

  19. Genetic Factors : • Adoption studies. • Twin studies. • Family studies. • Linkage studies : Chr 5 , 11 , x. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  20. Psychosocial Factors : • Life Events & Environmental stress. • Family. • Premobid personality factors. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  21. Specifiers Describing Most Recent Episode: With Psychotic features. With Atypical features. With Catatonic features. Postpartum Onset. Chronic. • Describing course of Recurrent Episodes: Rapid cycling. Seasonal pattern. Longitudinal course specifiers. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  22. Differential Diagnosis : Bipolar I Disorder , Bipolar II Disorder Bipolar III Disorder, cyclothymic disorder, Schizophrenia. Mood Disorders due to a general Medical condition. Substance – induced Mood Disorder. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  23. Course & Prognosis : Bipolar I Disorder. Bipolar II Disorder. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  24. Frequent ComplicationsOf Bipolar Disorder • High suicide rate • Cardiovascular mortality may be increased • Increased affective episodes and hospitalizations • Residual symptoms • Substance abuse • Never married or marital discord/divorce likely • Work impairment/academic underachievement Dar Al-Ajaza Al-Islamia Hospital in Beirut

  25. Treatment : Hospitalization. Pharmaco Therapy : - Lithium. - Anticonvulsants. - Other Agents. - Rapid Cycling. - Maintenance. Psychosocial Therapy. - Cognitive Therapy. - Interpersonal Therapy. - Behavior Therapy. - Psychoanalytically Oriented Therapy. - Family Therapy. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  26. Acute Phase Mood stabilizers (antimanic) Sedative agents: BZD Neuroleptics Antidepressant Maintenance Phase Mood stabilizers Other agents Pharmacological Treatments Dar Al-Ajaza Al-Islamia Hospital in Beirut

  27. Treatment Resistant Bipolar Depression • Limited data for bipolar I depression. • Depression often persists despite mood stabilizer. • SSRIs better tolerated, less likely to trigger mania than TCA & MAOIs. • Consider ECT for severe or delusional bipolar depression. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  28. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  29. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  30. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  31. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  32. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  33. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  34. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  35. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  36. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  37. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  38. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  39. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  40. To Sum Up • Bipolar disorder is a recurring mood disorder with a high morbidity and mortality (suicidal rate15 %). The acute phase (depressive or manic) has a good prognosis with specific treatments, and the disease is preventable and treatable. Dar Al-Ajaza Al-Islamia Hospital in Beirut

  41. Thank you Dar Al-Ajaza Al-Islamia Hospital in Beirut

More Related