Bipolar Disorder Overview

Mood Disorders

• Also known as affective disorders, characterized by pervasive alterations in emotions manifested by depression, mania, or both
• Two main categories: Depressive disorders and Bipolar Disorders

Depressive Disorders

• Statistics: 18.8 million adults experience depressive disorders, with major depression being the leading cause of disability worldwide
• More women than men suffer from major depressive disorder
• Can occur in any age group, including infants, school-aged children, and adolescents

Bipolar Disorders

• Categories: Bipolar I Disorder (one or more manic or mixed episodes), Bipolar II Disorder (recurrent major depressive episodes with hypomanic episodes), and Cyclothymic Disorder (numerous periods of hypomanic symptoms and depressed mood)
• Characterized by rapidly alternating moods accompanied by symptoms of a manic and depressive episode

Risk Factors for Mood Disorders

• Prior episodes of depression
• Family history of depressive disorders
• Prior suicide attempts
• Female gender
• Age of onset younger than 40 years
• Post-partum period
• Medical comorbidity associated with high risk of depression
• Lack of social support
• Stressful life events
• Current alcohol or substance abuse

Etiology of Mood Disorders

• Biologic theories of depression
• Postpartum depression (occurs during the first 30 days postpartum)
• Psychotic depression (delusions or hallucinations in conjunction with mood disturbance)
• Seasonal affective disorder (SAD, depression occurring in conjunction with seasonal change)

Dysthymic Disorder

• Exhibits symptoms similar to major depressive disorder, but not as severe
• Does not include symptoms such as delusions, hallucinations, impaired communication, or incoherence
• Clinical symptoms persist for 2 years or more, with normal mood swings for a few days or weeks

Bipolar Disorder

• Formerly known as manic-depressive illness
• Involves extreme mood swings from episodes of mania to episodes of depression
• Descriptive terms used to describe the labile affect or mood changes: Euphoria, Elation, Rapid-cycling, Hypomania, and Mania

DSM-IV-TR Criteria for Manic Episode

• Distinct period of abnormal and persistent elevated, expansive, or irritable mood that lasts at least 1 week (or less if hospitalization is required)
• At least three of the following symptoms must occur during the episode (or four if the patient is only irritable):
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Very talkative
  • Flight of ideas or subjective feeling that thoughts are racing
  • Distractibility
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for personal problems