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Review article SOJ Psychology
Bipolar Disorder: A Concise Overview of Etiology,
Epidemiology Diagnosis and Management: Review of
Literatures
Getinet Ayano*
Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
Received: September 30, 2016; Accepted: December 16, 2016; Published: December 28, 2016
*Corresponding author: Getinet Ayano, chief psychiatry professional and mhGap coordinator at Research and Training Department, Amanuel Mental Special-
ized Hospital, Addis Ababa, PO box: 1971 Ethiopia, Tel:+251927172968; E-mail: ayanogetinet@yahoo.com
Abstract
Bipolar affective disorder, or manic depressive Illness (MDI), is
a common, severe, and persistent Mental illness. This condition is a
serious lifelong struggle and challenge. Bipolar affective disorder is
characterized by periods of deep, prolonged, and profound depression
that alternate with periods of an excessively elevated or irritable mood
known as mania. Only one manic/hypomanic episode is required to
diagnose bipolar rather than unipolar disorder. Bipolar disorder is
further characterized as type I or type II. Type I is diagnosed when at
least one manic episode is identified.
Bipolar disorder occurs in approximately 1 percent of the
population. Bipolar II disorder and Bipolar disorder not otherwise
specified (NOS) account for another 2.5 percent of the population.
Bipolar disorder is almost always recurrent and can be associated
with severe illness-related Morbidity and increased medical mortality.
About 10 to 20 percent of patients with bipolar disorder die of their
illness by suicide.
Bipolar disorder is equally prevalent in men and women. It has an
early age onset. The most common age of onset of bipolar disorder is
1721 years. It is a highly disabling illness, and in fact a study.
Bipolar disorder is caused by bio psychosocial influences including
genetic, perinatal, neuroanatomic, neurochemical and other biologic
abnormalities. In addition psychological and socio environmental
factors are associated with a greater risk of bipolar disorders. The
role of genes in the susceptibility to mood disorders has long been
supported by family, twin, and adoption studies. That mood disorders
run in families is a common observation of patients and clinicians.
However, genes clearly only contribute a predisposition that must
interact with environmental factors in order to cause disease.
Treatment of bipolar disorders requires an integration of medical,
psychological, and psychosocial inputs.
Keywords: Bipolar; Mania; Hypomania; Cyclothymia; Mood
Stabilizers; Psychotherapy;
Background
Bipolar disorder is characterized by manic or hypomanic
states: the patient is either depressed, euthymic (normal in
mood), or hypomanic/manic. Bipolar disorder differs from
Symbiosis Group *Corresponding author email: ayanogetinet@yahoo.com
www.symbiosisonlinepublishing.com
Open Access
unipolar disorder by including manic states. No matter how
many times a patient is depressed; only one manic/hypomanic
episode is required to diagnose bipolar rather than unipolar
disorder. Bipolar disorder is further characterized as type I or
type II. Type I is diagnosed when at least one manic episode is
identified. Usually recurrent depression also occurs, but in 5 to
10 percent of cases there are no diagnosable major depressive
episodes, although almost always there will be minor depressive
episodes. Bipolar disorder type II requires the absence of even
one manic episode, and instead the occurrence of at least one
hypomanic episode and at least one major depressive episode.
The critical difference between mania and hypomania, in current
DSM-V nosology, is that mania requires significant social and
occupational dysfunction, while in hypomania significant social
and occupational dysfunction needs to be excluded. Durational
criteria are less strict for hypomania (a minimum of 4 days) than
for mania (a minimum of 1 week) [1].
Bipolar disorder is common and disabling [2]. The hallmark
of the disorder is mood elevation (mania or hypomania) [1].
Patients with bipolar I disorder have episodes of mania and
nearly always experience major depressive episodes. Patients
with bipolar II disorder suffer both hypomanic episodes and
major depressive episodes.
It is one of the most severe of the psychiatric disorders.
Bipolar disorder is among the most disabling and economically
catastrophic medical disorders, ranked by the World Health
Organization as one of the common illnesses contributing to the
global burden of disease [3].
It carries a lifetime risk of around 2.6–7.8%, and its early
onset and tendency to chronicity mean that its prevalence is
relatively high. The social and economic impact of the illness is
enormous, and its impact on sufferers and their families can be
devastating [4, 5].
Bipolar disorder is a clinical diagnosis. It must be differentiated
from other psychiatric and medical illnesses, as well as from
disorders such as heavy metal toxicity, adverse effects of drugs,
and vitamin deficiencies [1].
Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and
Management: Review of Literatures
Treatment of bipolar disorders requires an integration of
medical, psychological, and psychosocial inputs. The bulk of
care occurs in an outpatient setting and is best carried out by a
multidisciplinary team. Psychosocial rehabilitation is an essential
part of treatment [1].
Etiology of bipolar disorders
Research has identified several factors that contribute to the
risk of developing bipolar disorders. Bipolar disorder is a disease
caused by biopsychosocial influences including genetic, perinatal,
neuroanatomic, neurochemical and other biologic abnormalities.
In addition psychological and socio environmental factors are
associated with a greater risk of bipolar disorders [6, 7, 8].
Genetic factors
Different studies indicated that bipolar disorders have
high genetic transmission risks. Some of evidences for genetic
transmission of bipolar disorders are:
Family Studies: Studies indicate that bipolar disorders run
in families. First degree relatives of people with bipolar I disorder
are approximately 7 times more likely to develop bipolar I
disorder than the general population. Remarkably, offspring
of a parent with bipolar disorder have a 50% chance of having
another major psychiatric disorder. One longitudinal study
found that sub threshold manic or hypomanic episodes were a
diagnostic risk factor for the development of subsequent manic,
mixed, or hypomanic episodes in the offspring of parents with
bipolar disorder. In fact, unipolar disorder is typically the most
common form of mood disorder in families of bipolar probands.
However, the rate of bipolar disorder is only slightly elevated in
the families of unipolar probands. This familial overlap suggests
some degree of common genetic underpinnings between these
two forms of mood disorder [6].
Twin Studies: Twins who are reared together share the same
environment, but monozygotic (MZ) twins share all their genes,
while Dizy Gotic (DZ) twins share on average only 50 percent.
Twin studies compare the concordance rates in MZ and DZ twins.
The concordance rate refers to the proportion of co-twins who
are also affected or to the proportion of twin pairs where both
twins are affected. Twin studies demonstrate a concordance
of 3390% for bipolar I disorder in identical twins. As identical
twins share 100% of their DNA, these studies also show that
environmental factors are involved, and there is no guarantee
that a person will develop bipolar disorder, even if they carry
susceptibility genes [7, 8].
Adoption Studies: Adoption studies provide an alternative
approach to separating genetic and environmental factors in
familial transmission. Adoption studies have been conducted
using a variety of experimental designs, but the most common is
the adoptee as proband strategy. In this approach, probands are
identified who have a mood disorder and were adopted at birth.
Through this event, nature is separated from nurture. The rates
of psychiatric illness are then determined in both the biological
and adoptive parents. Numerous adoption studies prove that a
common environment is not the only factor that makes bipolar
Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of
Literatures. SOJ Psychol 3(1): 1-8.
Copyright:
© 2016 Ayano
disorder occur in families. Children whose biologic parents have
either bipolar I disorder or a major depressive disorder remain at
increased risk of developing an affective disorder, even if they are
reared in a home with adopted parents who are not affected [7,8].
Linkage Studies: Numerous linkage studies of bipolar
disorder have implicated many different chromosomal regions.
Bipolar disorder, especially bipolar type I (BPI) disorder, has a
major genetic component, with the involvement of the ANK3,
CACNA1C, and CLOCK genes [9, 15]. The evidence indicating a
genetic role in bipolar disorder takes several forms.
Pregnancy and Birth Complications (Perinatal factors)
An association between obstetric complications, structural
brain abnormality and early onset schizophrenia has been
reported in a number of investigations [16, 17] and reviewed
recently [12]. Although broadly defined or apparently unrelated,
obstetric complications may share a common pathophysiology,
namely foetal hypoxia [18]. Studies have demonstrated that
patients with bipolar disorder have increased rates of obstetric
complications and this was associated with an early illness onset
[19]. By contrast, little research has been carried out into the
relationship between obstetric complications and age of onset of
bipolar affective disorder. However, increased risks of perinatal
birth complications have also been reported in bipolar disorder
[20-25]. The significance of such findings in the causation of
bipolar disorder is still unclear; Scott’s review and metanalysis
of literature [24] failed to find a significant association between
obstetric complications and bipolar disorder.
Neurotransmitters (Biochemical factors)
Multiple biochemical pathways likely contribute to bipolar
disorder, which is why detecting one particular abnormality is
difficult. A number of neurotransmitters have been linked to this
disorder, largely based on patients’ responses to psychoactive
agents as in the following examples. The blood pressure
drug reserpine, which depletes catecholamines from nerve
terminals, was noted incidentally to cause depression. This led
to the catecholamine hypothesis, which holds that an increase in
epinephrine and nor epinephrine causes mania and a decrease
in epinephrine and nor epinephrine causes depression. Drugs
used to treat depression and drugs of abuse (e.g., cocaine)
that increase levels of monoamines, including serotonin, nor
epinephrine, or dopamine, can all potentially trigger mania,
implicating all of these neurotransmitters in its etiology. Other
agents that exacerbate mania include L-dopa, which implicates
dopamine and serotoninre uptake inhibitors, which in turn
implicate serotonin. Evidence is mounting of the contribution
of glutamate to both bipolar disorder and major depression. A
postmortem study of the frontal lobes of individuals with these
disorders revealed that the glutamate levels were increased [26].
Recent life events and bipolar disorder (Environmental
factors)
Overall, studies of life events have found that bipolar
individuals experience increased stressful events prior to
first onset and recurrences of mood episodes. Moreover,
Page 2 of 8
Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and
Management: Review of Literatures
most studies have found that negative life events precede the
manic/hypomanic as well as the depressive episodes of bipolar
individuals. Numerous studies indicate that from 20% to 66% of
bipolar patients experienced at least one stressful event rated as
independent of their behavior in the 1–3month period prior to
onset of a mood episode . In additions psychosocial stressors are
the major causes of relapse in bipolar patients [27, 28].
Epidemiology
Global prevalence of Bipolar disorder
Bipolar disorder was equated with classic manic depressive
(i.e., bipolar I) disorder, and the lifetime prevalence of bipolar
disorder was found to be approximately 1%. However, if
the diagnosis of bipolar II disorder (major depression with
hypomania, but not with mania) is much higher lifetime
prevalence rates of the broadly defined bipolar disorders, up to
at least 5%, were reported. The recent results of the National
Co morbidity Survey Replication has shown that the lifetime
prevalence estimates were Studies also indicate differences in
lifetime prevalence estimates for bipolar disorder type I (BPI)
(1.0%), bipolar disorder type II (BPII) (1.1%), and sub threshold
bipolar disorders (2.44.7%)[29].
Socio demographic factors
The gender ratio in bipolar disorder (all subtypes combined)
is approximately 1:1. However, among bipolar II patients and
in special subpopulations (mixed/dysphoric mania, mixed
depressive episode, winter depression, bipolar depression with
atypical clinical features, and rapid cycling bipolar disorder),
women are overrepresented. Looking at the depression–mania
continuum as a whole spectrum, there is a clear trend: The higher
the depressive component, the higher the proportion of women.
Consequently, in the rare cases of unipolar mania (manic episode
without any major or minor depression), men are markedly
overrepresented. The gender differences in lifetime prevalence
rates are more marked than in 1year and current prevalence
rates, which may be attributable—at least in part—to the
stronger male tendency to forget previous episodes and deny
emotionally negative events [30].
Diagnosing of bipolar disorders (Current
Diagnostic Criteria- DSM-5)
Seven bipolar disorder categories are included in DSMV:
bipolar I disorder, bipolar II disorder, cyclothymic disorder,
substance/medication induced bipolar and related disorder,
bipolar and related disorder due to another medical condition,
other specified bipolar and related disorder, and unspecified
bipolar and related disorder [1].
Bipolar I disorder
The bipolar I disorder criteria represent the modern
understanding of the classic manic depressive disorder or affective
psychosis described in the nineteenth century, differing from
that classic description only to the extent that neither psychosis
nor the lifetime experience of a major depressive episode is a
requirement. However, the vast majority of individuals whose
Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of
Literatures. SOJ Psychol 3(1): 1-8.
Copyright:
© 2016 Ayano
symptoms meet the criteria for a fully syndromal manic episode
also experience major depressive episodes during the course of
their lives (table 1).
Bipolar II disorder
Bipolar II disorder, requiring the lifetime experience of at
least one episode of major depression and at least one hypomanie
episode, is no longer thought to be a “milder” condition than
bipolar I disorder, largely because of the amount of time
individuals with this condition spend in depression and because
the instability of mood experienced by individuals with bipolar II
disorder is typically accompanied by serious impairment in work
and social functioning (table 2.)
Cyclothymic disorder
The diagnosis of cyclothymic disorder is given to adults who
experience at least 2 years (for children, a full year) of both
hypomanie and depressive periods without ever fulfilling the
criteria for an episode of mania, hypomania, or major depression
(table 3).
Management of bipolar disorders
Although mood stabilizers are the mainstay of the treatment
for bipolar disorders, research has found that psychosocial
interventions, including psychotherapy, can augment the clinical
improvement. Just as pharmacological agents are used to treat
presumed chemical imbalances, no pharmacological strategies
must treat no biological issues. The complexity of bipolar
disorders usually renders any single therapeutic approach
inadequate to deal with the multifaceted disorder. Psychosocial
modalities should be integrated into the drug treatment regimen
and should support it. Patients with bipolar disorders benefit
more from the combined use of mood stabilizers and psychosocial
treatment than from either treatment used alone [36].
Pharmacological managements
A number of medications are used to treat bipolar disorder
[31, 39] including:
• Mood stabilizers
• Anti-psychotics
• Anti-depressants
• Anti-anxiety medications
Most people with bipolar I or bipolar II will need mood
stabilizers to control their manic or Hypomanic episodes.
Commonly used moods stabilizers include:
• Tegretol (carbamazepine)
• Depakote (divalproex sodium., valproic acid)
• Lamictal (lamotrigine)
• Lithobid (lithium)
Antipsychotic drugs may also be used to control episodes of
depression or mania, especially when delusions or hallucinations
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Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright:
Management: Review of Literatures © 2016 Ayano

are occurring. Examples of drugs in this class include: • Saphris (asenapine)

• Abilify (aripiprazole) • Symbyax (olanzapine and fluoxetine)

Table 1: DSM-V Diagnostic Criteria for bipolar I disorder

DSM-V Diagnostic Criteria for bipolar I disorder
For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by
and may be followed by hypomanic or major depressive episodes.
Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed
activity or energy, lasting at least 1 Week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only
irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non goal directed
activity).
7. Excessive involvement in activities that have a high potential for painful consequence (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments).
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to
prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another
medical condition.
Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully
syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.
Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning;
at least one of the symptoms is either
(1) Depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation
made by others (e.g., appears tearful).
Note: In children and adolescents, can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account
or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than5% of body weight in a month), or decrease or increase in
appetite nearly every day.
Note: In children, consider failure to make expected weight gain.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed
down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self reproach or guilt about
being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for
committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
Note: Criteria A constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the
diagnosis of bipolar I disorder.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from va natural disaster, a serious medical illness or disability) may
include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble
a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive
episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of
clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.
Bipolar I Disorder
A. Criteria have been met for at least one manic episode (Criteria AD under “Manic Episode” above).
B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 4 of 8
Literatures. SOJ Psychol 3(1): 1-8.
Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright:
Management: Review of Literatures © 2016 Ayano

Table 2: DSM-V Diagnostic Criteria for bipolar II disorder

DSM-V Diagnostic Criteria for bipolar II disorder

For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanie episode and the following criteria
for a current or past major depressive episode:
Hypomanie Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or
energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more)of the following symptoms have persisted (four if the
mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are
psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).
Note: A full hypomanie episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully
syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanie episode diagnosis. However, caution
is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as
sufficient for diagnosis of a hypomanie episode, nor necessarily indicative of a bipolar diathesis.
Bipolar II Disorder
A. Criteria have been met for at least one hypomanie episode (Criteria AF under “Hypomanic Episode” above) and at least one major depressive
episode (Criteria AC under “Major Depressive Episode” above).
B. There has never been a manic episode.
C. The occurrence of the hypomanie episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically
significant distress or impairment in social, occupational, or other important areas of functioning.

Table 3:DSM-V Diagnostic Criteria for Cyclothymic Disorder

DSM-V Diagnostic Criteria for Cyclothymic Disorder

A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet
criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
B. During the above 2year period (1 year in children and adolescents), the hypomania and depressive periods have been present for at least half the
time and the individual has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanie episode have never been met.
D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism) course.

Table 4: Most commonly used mood stabilizers and indications

Agent Indications or preferred to use

Euphoric, pure(classic )mania, no psychosis, no rapid Cyclic previous good personal or family response and sequence of mania-
Lithium
depression-euthemia.

Valproate Irritable mania, mixed episode, rapid cycling, secondary mania, comorbid substance use, severe with psychosis

Carbamazepine History of trigeminal neuralgia, comorbid post traumatic stress disorders, comorbid substance issues, Severe mania( with
psychosis), comorbid anxiety and panic attack, commorbid migraine headache, Irritable mania
Olanzapine
FDA approved for acute and maintenance treatment for mania.

Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 5 of 8
Literatures. SOJ Psychol 3(1): 1-8.
Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and
Management: Review of Literatures
• Latuda (lurasidone)
• Zyprexa (olanzapine)
• Seroquel (quetiapine)
• Risperdal (risperidone)
• Geodon (ziprasidone)
An antidepressant may also be used to manage depressive
episodes, in conjunction with a mood stabilizer or an
antipsychotic.
Finally, Benzodiazepines Diazepam, Lorazepam, Clonazepam
or another type of anti anxiety medication may be used.
Psychosocial interventions
Psycho education and more formal psychotherapy can
improve outcome when used in conjunction with maintenance
pharmacotherapy. Adjunctive psychosocial therapies should be
considered early in the course of illness to improve medication
adherence, identify prodromes of relapse, decrease residual
symptoms (particularly depressive) and suicidal behavior,
and help move patients towards a comprehensive functional
recovery [40–46]. For bipolar disorders Psychological and
social (psychosocial) interventions are important in addition to
continuing on medication. These may include:
Psycho education: Psycho educational interventions include
any discrete programme involving interaction between an
information provider and service users or their careers which
has the primary aims of offering information about the condition
and the provision of support and management strategies.
Complex psycho education was defined as any group programme
involving an explicitly described educational interaction between
the information provider and the patient/carer as the prime
focus of the intervention [47, 48]. Patients/carers should be
provided with information, support and different management
strategies, including: illness awareness, treatment compliance,
early detection of prodromal symptoms and relapse, lifestyle
regularity.
Cognitive behavioral therapy (CBT): A structured
and collaborative therapeutic approach, CBT is a discrete
psychological intervention which aims to make explicit
connections between thinking, emotions, physiology and behavior
with respect to current or past problems, primarily through
behavioral experiments and guided discovery. CBT seeks to
achieve systemic change through the reevaluation of perceptions,
beliefs or reasoning thought to cause and maintain psychological
problems. The aim is to help the individual normalize and make
sense of their psychotic experiences, and to reduce the associated
distress and impact on functioning. Targeted outcomes include
symptom reduction, relapse reduction, enhancement of social
functioning, development of insight, amelioration of distress, and
the promotion of recovery [49, 50].
Family intervention: Family intervention is a discrete
psychological intervention with a specific supportive, educational
or treatment function which involves problem solving/crisis
Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of
Literatures. SOJ Psychol 3(1): 1-8.
Copyright:
© 2016 Ayano
management and/or intervention with the identified service
user. Family intervention for individuals diagnosed with bipolar
disorder has developed out of the consistent finding that
the emotional environment within a family was an effective
predictor of relapse. In this context, ‘family’ includes people who
have a significant emotional connection to the individual, such
as parents, siblings and partners. Different models of family
intervention aim to help families cope with their relative’s
problems more effectively, provide support and education for the
family, reduce levels of distress, improve the ways in which the
family communicates and negotiates problems, and try to prevent
relapse by the service user [51]. Family sessions with a specific
supportive or treatment function based on systemic, cognitive
behavioral or psychoanalytic principles, which must contain
at least one of the following psycho educational intervention,
problem solving/crisis management work and intervention with
the identified patient.
Interpersonal and social rhythm therapy (IPSRT):
Interpersonal and social rhythm therapy (IPSRT) was defined
as discrete, time limited, structured psychological intervention
derived from an interpersonal model of affective disorders [52,
53]. It focuses on:
• Working collaboratively with the therapist to identify the
effects of key problematic areas related to interpersonal
conflicts, role transitions, grief and loss, and social skills,
and their effects on current symptoms, feelings states
and/or problems
• Seeking to reduce symptoms by learning to cope with or
resolve these interpersonal problem areas
Seeking to improve the regularity of daily life in order to
minimize relapse.
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