BIPOLAR DISORDER

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BIPOLAR DISORDER

• DR. NAZISH NASEEM

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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

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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.

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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.

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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 fathers will.
• Could not maintain good marital relationship and
  shifted to the hostel and indulged into
  addiction, ultimately brought to PIMH.

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FAMILY HISTORY

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

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PRECIPITATING FACTORS

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

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

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

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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

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TREATMENT

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

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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.

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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.