Bipolar Disorder

From Anvita Health Wiki

Contents 1 Introduction 2 Epidemiology 3 Genetics 4 Clinical-manifestations 5 Diagnostic-criteria 6 Laboratory 7 Complications 8 Differential-diagnosis 9 Management 10 More General Terms 11 Additional Terms 12 Internet Database 13 References

Introduction

• A major mood disorder characterized by episodes of major depression & mania or hypomania, formerly called manic- depressive psychosis, circular type.

Epidemiology

• prevalence 9.8% in one study [5]; lower in other populations
• 20% of non-responders to anti-depressants [12]

Genetics

• polymorphism in TPH2 gene associated with bipolar diorder [11]
• PDLIM5 is commonly increased in the brain of patients with bipolar disorder, schizophrenia, & major depression
• overexpression of RIC3 in brains from patients with bipolar disease or schizophrenia
• other implicated genes: CPLX2

Clinical-manifestations

• episode may be manic, depressed, hypomanic, or mixed manic type
• mixed episodes: manic (irritable, talkative) but depressed rather than euphoric
• elevated, expansive or irritable mood > 1 week, grandiosity, decreased need for sleep
• symptoms causing disruption of social or occupational functioning

Diagnostic-criteria

• bipolar I disorder requires one or more episodes of mania
• bipolar II disorder requires one or more episodes of hypomania & is excluded by the history or presence of a manic episode.

Laboratory

• thyroid function tests
• anti-nuclear antibody

Complications

• suicide rate, 10-15% if untreated [2]
• substance abuse increase risk of mania with antidepressants
• increased risk of mortality

• largely due to

• cardiovascular disease
• lung disease

• possible a result of

• lifestyle of the mentally ill
• adverse effects of medications [16]
  

• disease interaction(s) of bipolar disorder with anxiety
• disease interaction(s) of psychosis with functional incontinence

Differential-diagnosis

• thyrotoxicosis
• partial-complex seizures
• systemic lupus erythematosus
• adverse effects of corticosteroids

Management

• lithium carbonate

• patients on lithium 3 times less likely to attempt suicide than patients on valproate [3]

• valproic acid (drug of choice for mixed episodes) [2]

• combination of lithium carbonate plus valproate may be better than either alone for preventing relapse [13]

• other agents [2]

• carbamazepine
• oxcarbazepine ( Trileptal)
• lamotrigine ( Lamictal) for depressive episodes [9]

• antipsychotic agents for severe mania or psychosis

• olanzapine ( Zyprexa)

• olanzapine + fluoxetine [9] greater effectiveness & increased risk of adverse effects

• risperidone ( Risperdal)
• aripiprazole ( Abilify) [14]
• better than anticonvulsants for manic episodes [15]
• haloperidol

• most effective agent [15]
• significantly more effective than all other agents except risperidone & olanzapine [15]

• antidepressants

• add to lithium or lamotrigine for severe depression
• do NOT use SSRIs (or other antidepressants) alone; may trigger manic attack [14]
• Symbyax, 1st FDA approved agent for bipolar depression [4]

• intensive clinical management (education, sleep hygiene, non-specific support, attention to physical symptoms &/or interpersonal & social rhythms therapy ( IPSRT) may be of benefit [6]
• omega 3 fatty acids, 1-2 g/day may be of benefit [7]
• screening: mood disorder questionnaire

More General Terms

• mental disorder

Additional Terms

• mood disorder questionnaire

Internet Database

OMIM: 125480
OMIM: 309200

References

1. Prescriber's Letter 7(7):41 2000
2. Prescriber's Letter 9(6):33 2002
3. Prescriber's Letter 10(12):70 2003 Detail-Document#: [1] (subscription needed) [2]
4. Prescriber's Letter 11(2):10 2004 Detail-Document#: [3] (subscription needed) [4]
5. Journal Watch 25(7):57, 2005 Das AK, Olfson M, Gameroff MJ, Pilowsky DJ, Blanco C, Feder A, Gross R, Neria Y, Lantigua R, Shea S, Weissman MM. Screening for bipolar disorder in a primary care practice. JAMA. 2005 Feb 23;293(8):956-63. PMID: [5]
6. Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, Grochocinski V, Houck P, Scott J, Thompson W, Monk T. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry. 2005 Sep;62(9):996-1004. PMID: [6]
7. Frangou S et al, Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: Randomized double-blind placebo-controlled trial. Br J Psychiatry 2006, 188:46 PMID: [7]
8. Nierenberg AA, Ostacher MJ, Calabrese JR, Ketter TA, Marangell LB, Miklowitz DJ, Miyahara S, Bauer MS, Thase ME, Wisniewski SR, Sachs GS. Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. Am J Psychiatry. 2006 Feb;163(2):210-6. PMID: [8]
9. Brown EB et al, A 7-week, randomized, double-blind trial of olanzapine/ fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. J Clin Psychiatry 2006, 67:1025 PMID: &dopt=Abstract
10. Manwani SG et al, Substance use disorder and other predictors of antidepressant- induced mania: A retrospective chart review. J Clin Psychiatry 2006, 67:1341 PMID: [9]
11. Van Den Bogaert A et al, Association of brain-specific tryptophan hydroxylase, TPH2, with unipolar and bipolar disorder in a Northern Swedish, isolated population. Arch Gen Psychiatry 2006, 63:1103 PMID: [10]
12. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, American College of Physicians, Philadelphia 2006, 2009
13. The BALANCE investigators and collaborators Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial Lancet. 2010 Jan 30;375(9712):385-95. Epub 2010 Jan 19. PMID: [11] doi:10.1016/S0140-6736(09)61828-6 [12]
14. Prescriber's Letter 18(6): 2011 COMMENTARY: Pharmacotherapy of Bipolar Disorder in Adults CHART: Comparison of Atypical Antipsychotics GUIDELINES: Management of Bipolar Disorder in Adults (BD) (2010) Detail-Document#: [13] (subscription needed) [14]
15. Cipriani A et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. PMID: [15] Lancet 2011 Aug 17 [16]
    - Berk M and Malhi GS. Should antipsychotics take pole position in mania treatment? Lancet 2011 Aug 16 <PubMed> PMID: [17] <Internet> [18]
16. Hoang U et al. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: Retrospective study of linked English hospital episode statistics, 1999-2006. BMJ 2011 Sep 13; 343:d5422 PMID: [19]
17. NIH Institute and Center Resources [20]
18. National Guideline Clearinghouse
19. VA/DoD Clinical Practice Guidelines Management of Bipolar Disorder in Adults [21]
    - Olanzapine and valproate semisodium in the treatment of acute mania associated with bipolar I disorder. National Institute for Clinical Excellence (NICE) ngc-guideline: [22]
    - Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. American Academy of Child and Adolescent Psychiatry ngc-guideline: [23]
    - VA/DoD clinical practice guideline for management of bipolar disorder in adults. ngc-guideline: [24]

bipolar affective disorder