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Bipolar Disorders Criteria and Treatment (Subtypes of BD and MDD (Rapid…
Bipolar Disorders Criteria and Treatment
The Disorders
Bipolar 1: Criteria met for at least one manic episode, based on type, severity, presence of psychotic features and in remission/not
For manic episode: symptoms last for 1 week or require hospitalisation and cause significant distress/impairment; for hypomanic episode: symptoms last 4 days and impairment is not marked
Manic episodes: at least 3 symptoms (4 if mood is irritable): inflated self esteem, decreased need for sleep, unusual talkativeness, flight of ideas, distracted, increased goal-directed activity, involvement in undesirable consequence activities
Bipolar 2: criteria met for at least on hypomanic episode AND one major depressive episode
Cyclothymic disorder: numerous hypomanic symptoms and depressive symptoms (that do not meet criterion, for at least 2 years, symptoms do not clear for 2 months, significant distress)
Epidemiology
Prevalence: BP1 ~0.6%, BP2 ~ 0.4 - 2%, Cyclothymia: ~4.%
Onset: over than half before 25, equal in men and women
Comorbidities: 2/3 comorbid anxiety, 1/3 history of substance abuse
Suicide attempts: BP1: ~1/4, BP2: ~1/5
1/3 BP1 unemployed and unable to work ~25% of time
Risks for diabetes, obesity, thyroid disease
Subtypes of BD and MDD
Rapid cycling: moving quickly in and out of depressive and manic episodes - without any normal state, rapid switching pattern commences, increased suicide risk, around 20-40% of BD sufferers
Seasonal Affective Disorder: bipolar --> depressed in winter, manic in summer
Psychotic features: mood congruent (characteristics align with mood)/incongruent, 5-20%
Mixed: at least 3 manic symptoms present during depressive episode and vice versa
Catatonic: stuporous state (not fully conscious) or catalepsy (psycho-motive disturbances
Melancholic: more severe somatic symptoms
Atypical: can still find pleasure despite depressive episodes, range is symptoms is quite large, more severe, more suicidality
Post partum: distinct from post-partum depression, onset 4 weeks post-birth, could be due to hormones
Treatment
Combination of psychotherapy and AD medication most effective
Psychological treatment: psycho-education, cognitive therapy, family focused treatment (these tend to focus on relieve depressive symptoms
Biological treatments: Lithium remains gold standard, relieves symptoms in short term, more effective in treating manic symptoms, up to 80% experience some benefit but 70% of these relapse in 5 years
Anticonvulsants (Valproate), antipsychotics (Olanzapine) and antidepressants may be used when Lithium not tolerated
Electroconvulsive therapy: when all else has failed, volt to brain, massive functional changes, increases serotonin, blocks stress hormones, neurogenesis in hippocampus, however > decline in cognitive function in 6 months