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Bipolar and other mood disorders

 

Definition

Bipolar disorder, also referred to as ‘manic depression’, is a mood disorder characterised by both ‘lows’ (depression) and ‘highs’ (mania). Bipolar I Disorder is characterised by more severe manic episodes whilst Bipolar II Disorder tends to have less severe manic episodes and more prolonged depressive episodes. The most common age of onset is mid-late 20s but it can arise in childhood and adolescence. A seasonal component is not uncommon with manic episodes more likely in the Spring and Summer with depressive ones more in the Winter. Rapid cycling (4 or more mood swings a year) Bipolar Disorder can be particularly disruptive with mood swings occurring within hours. Severe episodes, either manic or depressive, can be associated with psychotic symptoms e.g. delusions and hallucinations.

Clinical Symptoms

Manic Episode

  • Euphoric and overly optimistic
  • Inflated self-esteem and boasting
  • Pressured speech and racing thought
  • Over-activity and dis-inhibition
  • Irritability and aggressive behaviour
  • Poor judgement
  • Increased libido
  • Reckless and inappropriate behaviour e.g. overspending and drug/alcohol misuse
  • Short Attention span
  • Psychotic symptoms such as hallucinations and delusions

Depressive Episode

  • Persistent low mood
  • Reduced capacity for interest and enjoyment
  • Decrease in activity – avoidance of social situations and activities at work or home
  • Reduced self-esteem and self-confidence and ideas of guilt or worthlessness
  • Thoughts of hopelessness and suicidal ideation
  • “Physical” symptoms – sleep disturbance, especially early morning waking, fatigue and reduced energy, slowing of thoughts or movement, agitation, tearfulness, loss of libido and changes in appetite and weight
Causes

A number of factors are thought to predispose an individual to bipolar disorders:

  • Biological – a family history significantly increases the likelihood of developing a bipolar disorder. Approximately 20% of sufferers have a first degree relative with a mood disorder. Imbalances of neurotransmitter (serotonin and noradrenaline) and hormonal metabolism have both been identified in precipitating manic and depressive episodes. Illicit drugs and alcohol can exacerbate both manic and depressive episodes.
  • Psychosocial – traumatic or stressful events, bereavements and other losses can trigger both manic and depressive episodes. Personality factors are more likely to be relevant in triggering depressive episodes.
Treatment

Effective treatment of bipolar disorder, where insight is often limited, especially in manic episodes, relies on an open and honest relationship with professionals, patient education and family support.

  • Medication – mood stabilising medications (e.g. lithium and anticonvulsants in particular Depakote) target the neurotransmitters involved in mood swings. Anti-psychotic medications (e.g. olanzepine and quetiapine) are sometimes necessary to deal with severe manic symptoms and psychotic symptoms occurring in both mania and depression. Antidepressants (see Depression) should be used with caution as they may trigger a manic episode.
  • Psychological – cognitive behavioural therapy (CBT) helps the individual learn strategies for predicting and better managing disturbances in mood, reducing relapses and minimising their negative impact. Individual and family therapy sessions help deal with previous adverse life events and relationship difficulties further minimising the risk of relapse.

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