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BIPOLAR DISORDER

BIPOLAR DISORDER. DR. NAZISH NASEEM. BIPOLAR AFFECTIVE DISORDER. Mania / Hypomania Bipolar Depression How to identify (DSM IV) Expensive, elated, irritable, elevated mood at least for one week. Delusions of grandeur Pressure of speech / flight of ideas Decrease Sleep

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BIPOLAR DISORDER

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  1. BIPOLAR DISORDER DR. NAZISH NASEEM

  2. BIPOLAR AFFECTIVE DISORDER • Mania / Hypomania • Bipolar Depression How to identify (DSM IV) • Expensive, elated, irritable, elevated mood at least for one week. • Delusions of grandeur • Pressure of speech / flight of ideas • Decrease Sleep • Excessive involvement in pleasurable activities • Distractibility • Psychomotor agitation / increase in goal directed activity

  3. EPIDIOMOLOGY • Life time risk for bipolar disorder is 1%. • Life time risk for 1st degree relatives of patients with bipolar disorder is about 10%. • Prevalence in men and women is the same. • Mean age of onset is about 21 years • Bipolar disorder is highly co-morbid with other disorders, like anxiety disorder and substance misuse disorder.

  4. CASE HISTORY • Saba Agha, 20 years of age, wellkempt with good rapport and intense eye contact, irritable, quarrelsome and decreased sleep for the last one week. • After quarreling with her father she left home and she was not on any treatment at the time of admission.

  5. PAST PSYCHIATRIC HISTORY Total duration of illness 5-years. Considered immoral and bad girl by the family instead of seeking treatment. Indulged into a relationship and married against his father’s will. Could not maintain good marital relationship and shifted to the hostel and indulged into addiction, ultimately brought to PIMH.

  6. FAMILY HISTORY Strict, short tempered and discipliner father. Not allowed to attend school. Frequently beaten up Positive family history of mood disorder.

  7. PRECIPITATING FACTORS This episode was precipitated by • Quarrel with father • Separation from her daughter and husband. • Addiction

  8. PREDISPOSING FACTORS • Strong family history of mood disorder in grandmother & aunt (both paternal). • Short tempered strict father. • Stressful family environment.

  9. PERPETUATING FACTORS • Poor family support. • Conflict of father and husband lead to marital disharmony. • Poor compliance of treatment.

  10. TREATMENT PHARMACOLOGICAL TREATMENT • Antipsychotics e.g. Haloperidol, Chlorpromazine & Resperidone • Sedatives e.g. Lorezepam, diazepam & alprezolam • Mood stabilizer e.g. Carbamezapine, Sodium Valporate & Topiromate • Depot Injections e.g. Flupenthixol • Procyclidine • ECT

  11. TREATMENT PSYCHOLOGICAL TREATMENT • Individual Therapy • Cognitive Therapy • Family Therapy • Family Counseling

  12. TREATMENT SOCIAL TREATMENT • Interpersonal conflicts Amongst the family should be resolved. Differences between her in laws and father should be resolved Her husband and parents should be told about her mental illness and guidelines should be given regarding her treatment and follow-ups.

  13. PROGNOSIS • If the marital problems improve then immediate prognosis is good. • However several predisposing factors noted above indicate that she may develop further manic disorders particularly at future times of stress.

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