Bipolar I Disorder ( B-I-D

Def. Characterized by at least one episode of mania & subsequent depression or hypomania or mixed episode. Etiology Biological factors Genetic Neurochemical

Dopamine Norepinephrine Psychosocial factors Manic episodes could be as a defense against underlying depression Life events & environmental stress Epidemiology Life time prevalence of Bipolar I disorder is 0.4-1.6% Bipolar I Disorder prevalence equals in men & women. Common onset is in the teenage years, the 20, or the 30s, Manic episodes predominate in youth & depressive episodes in the later life

Vegetative disturbances IV. II. Psyhcomotor Disturbances -Movements are faster /hyperactive.cont Clinical presentations A/Depressive episode(Sxs & signs the same as in MDD) B/Hypomanic episode(mild form of mania) C/Manic episode B/Manic episode Clinical presentations: I. -Experiences an unusual sense of physical well being -They are impulsive & disinhibited . Mood disturbances II. Pyschomotor disturbances III.Mood Disturbances Elation & euphoria associated with laughing & gesturing Low frustration tolerance. which may lead to feelings of anger & hostility. Cognitive distortions I.

.cont III/ vegetative Disturbance 1. weight loss 3.Accelerated thinking process .attention too easily withdrawn to unimportant external stimuli) 3.Distractibility(i.Thinking & perception are unusually sharp . Sleeplessness 2.Flight of ideas or subjective experience that thoughts are racing.having many sexual partners . . gambling . e. hypersexualitey IV/ Cognitive distortions 1.e.g. Poor judgment .Grandiosity -Inflated self-esteem -Grandiose sense of confidence & achievements -delusion of grandeur 2.May engage in activities that harm them & their loved one.

Cont. Course & prognosis course : . -5-15% of persons with bipolar I disorder have 4 0r m0re episodes per year(rapid cycler) -Untreated manic episode lasts about 3 months. -Most often starts with depression -Most patients experience both depressive and manic episode. depressive.The first episode could be manic. or mixed. -10-20% patients experience only manic episodes. Prognosis On long-term follow up : .15% of all patients with B-I-D are well -45% are well but have multiple relapses -30% are in partial remission -10% are chronically ill .

Infllated self-esteem or grandiosity 2.Cont.Excessive involvement in pleasurable activities that have a high potential for painful consequences C. Abnormally & persistently elevated.Decreased need for sleep 3.Flight of ideas or subjective experience that are racing 5.or irritable mood.Increased in goal directed activity or psychomotor agitation 7.More talkative than usual 4. last at least 1 week B. DSM-IV-TR criteria of manic episode A. The symptoms are not due to substances.expansive. Marked functional impairment D. During the period of mood disturbance having 3 or more of the following Sxs : 1. or a GMC . medication.Distactibilty 6.

speedy thoughts/flight of ideas S.decreased judgment D.speedy talk/over talkativeness Hypmanic episode have the same Sxs as manic episode except: -psychotic features -need for hospitalization -sever functional impairment .irritability N.increased activity D.distractibility I.grandiosity I.need for sleep decreased E.elevated mood S.Criteria for mania/hypomania episode G.

the Ddx is the same as for a Ddx of MDD -When the patient is in manic episode the Ddx includes the following : 1.Mood disorder caused by GMC & Substance-induced mood disorder 4.Schizoaffective disorder 5.Schizophrenia .Differential Diagnosis -when the patient with B-I-D has a depressive episode.Cyclothymic disorder 3.Bipolar-II-disorder 2.

diazepam) 3.Antipsychotics -psychotic feature -short duration of treatment -high. mania) -should be given with Moodstablizer -SSRIs or II.potent 2benzodiazepines(lorazepam.cont Rx I. Others 1. short term c. acute b.psychotherapy . long-term 1.Antidepressants -caution(hypomania. Pharmacotherapy a.Moodstablizers 4.ECT 2.

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