This is a powerpoint presentation on bipolar affective disrder. Gives a basic information on the disorder.

1. DR. D. RAJ KIRAN, DNB
SENIOR RESIDENT
DEPT. OF PSYCHIATRY
KIMSRF
Bipolar Affective Disorder
UG class

2. Introduction
 Mood- a pervasive and sustained emotion or feeling
tone that influences a person’s behavior and colors
his/her perception.
 Disorders of mood- affective disorders.
 Adjectives used- sad, empty, distressed, irritable,
cheerful, euphoric, elated, exalted, ecstatic etc..,
 Normal mood- Euthymic.

3.  Uni-polar depression: only episodes of major
depression.
 Bi-polar depression: episodes of both mania and
depression.
 No Uni-polar or Bi-polar mania…

5.  Bipolar disorder 1- Mania and Depression
 Bipolar disorder 2- Hypomania and Depression
 Hypomaina- episode of manic symptoms, but does
not meet the criteria for manic episode.
 Cyclothymia and Dysthymia- represent less severe
forms of bipolar disorder and major depression.

6. History
 Jules Falret- ‘folie circulaire’; refers to
alternating depression and mania.
 Karl Kahlbaum- ‘cyclothymia’; refers to
mania and depression as stages of same
illness.
 Emil Kraeplin- ‘manic-depressive
psychosis’; based on knowledge gained.
 Absence of forgetfulness and deteriorating
course differentiated it from ‘dementia
precox’.

7. How common?
Condition Lifetime prevalence (%)
Bipolar disorder 1 0 – 2.4
Bipolar disorder 2 0.3 – 4.8
Cyclothymia 0.5 – 6.3
Hypomania 2.6 – 7.8
•Gender
•Depression- females > males
•BPAD- males > females
•Mania- males > females
•Age
•BPAD 1- from childhood to 50 yrs (mean age- 30yrs)
•Marital status
•More common in single or divorced than married.

8. Etiology
 Biological factors
 Neurotransmitters- NE, 5HT, Dopamine.
 Alterations in hormones- HPA, Thyroid, GH, PRL.
 Alteration in sleep neurophysiology.
 Genetic factors- hereditary is documented.
 Psychosocial factors
 Life events and environmental stress
 Personality factors.

9. Symptoms- mania
 Symptoms present atleast for 1 week.
 Mood- elevated, expansive or irritable and definitely
abnormal for the individual Concerned.
 At least three of the following must be present –
 Increased activity;
 Increased talkativeness;
 Subjective experience of thoughts racing;
 Loss of normal social inhibitions;
 Decreased need for sleep;
 Inflated self-esteem or grandiosity;
 Distractibility or constant changes in activity or plans;
 Reckless or careless behaviour;
 Marked sexual energy.

10. Examination
 General appearance and behavior- excited, talkative,
hyperactive.
 Psychomotor activity- increased
 Speech- Puns, jokes, rhymes, clanging, neologisms.
 Mood- euphoric/ elated/ exalted/ ecstatic.
 Thought- over confident, grandiose, extraordinary
abilities, expansive plans.
 Perception- ? Audit Hallucin

11. Symptoms- depression
 Should last for at least 2 weeks.
 Atleast 2 of the following-
 Low mood.
 Loss of interest or pleasure in activities;
 Decreased energy or increased fatiguability.
 An additional symptoms (with at least four)-
 Loss of confidence and self-esteem;
 Unreasonable feelings of guilt;
 Recurrent thoughts of death or suicide, or any suicidal behaviour;
 Complaints or evidence of diminished ability to think or concentrate,
such as indecisiveness or vacillation;
 Change in psychomotor activity, with agitation or retardation;
 Sleep disturbance;

12. Examination
• General appearance and behavior- down cast gaze,
no ETEC, rapport diff to establish, tearful.
• Psychomotor activity- decreased
• Speech- decreased tone and volume.
• Mood- depressed
• Thought- hopelessness, helplessness.
• Perception- ? Audit Hallucin

13. Veraguth’s fold- Triangle
shaped fold in the nasal
corner of upper eyelid.
Omega sign- occurrence of a fold like
the Greek letter omega on the
forehead above the root of the nose,
produced by the excessive action of
corrugator muscle.

14. Rating
 Young’s Mania Rating Scale
 Elevated mood
 Increased motor activity
 Sexual interest
 Sleep
 Irritability
 Speech
 Language
 Content
 Disruptive-Aggressive behavior
 Appearance
 Insight

15. Treatment
 Goals-
 Patient’s safety
 Complete diagnostic evaluation
 To target pt’s total wellbeing
 Addressing stressful life events
 Hospitalization-
 Risk of suicide/ homicide.
 Abnormal decision making
 Not compliant on treatment
 Co-morbid disorders
 Dent in patient’s support system
 ECT/ any other procedure

16.  Pharmacotherapy-
 Acute
 Maintenance
 Acute mania-
 Mood stabilizers- Lithium (0.8 to 1.2 mEq/L), Valproate,
Carbamazepine, Oxcarbazepine.
 Antipsychotics- Olanzapine, Risperidone, Quetiapine,
Haloperidol.
 Benzodiazepines- Lorazepam, Diazepam.

17.  Maintenance-
 Preventing the recurrences- greatest challenge
 Managing the long term side effects- important
 Drugs- Lithium (0.6 to 0.8mEq/L), Valproate, Carbamazepine.
 In Bipolar depression- Lamotrigine.
 Side effects- sedation, cognitive impairment, tremor, weight
gain, rash (SJS), thyroid abnormalities.

18.  Psychotherapy-
 Primary modality in mania- pharmacotherapy
 Supplementary to pharmacotherapy
 Interpersonal Social Rhythm Therapy (IPSRT)
 Family therapy
 Others-
 Electro Convulsive Therapy (ECT)

19. Summary- BPAD Rx
Treatment
Pharmacotherapy
Acute
Mood
stabilizers
Antipsychotics
Maintenance
Mood
stabilizers
Antipsychotics
Psychotherapy
Cognitive
Behavior Therapy
(CBT)
Interpersonal
therapy
Family therapy
IPSRT
Others
ECT
rTMS
VNS
Phototherapy

20. Course
 Often starts with depression.
 Recurring.
 Manic episodes- rapid onset but evolve over few weeks.
 Untreated mania- lasts 3months.
 Single manic episode- 90% another episode.
 Time between episodes decreases over years of disease.
 Rapid cycling: > 4episodes per year.