Bipolar Disorder: Types, Symptoms and Causes

Bipolar disorder is a mood disorder in which episodes of mania, depression, hypomania, and mixed episodes can be seen. Even a single episode of mania is considered bipolar disorder and it is very important to diagnose bipolar disorder by taking a perfect history because cases have been seen in which the hypomanic phase of bipolar disorder is diagnosed as depression and leads to wrong medication prescription.

Types of Bipolar Disorder

• Bipolar I disorder- the patient has one episode of mania and one episode of depression.
• Bipolar II disorder- the patient has one episode of hypomania plus one episode of depression

Also Read: Illness Anxiety Disorder: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Bipolar I Disorder

The prevalence of this disorder is equal in males and females but manic episodes are more common in males whereas depressive episodes are more common in females.

Symptoms (MEDIGFAST)

• Mood elation
• Energy (high)
• Distractibility
• Impulsivity ( Hypersexuality, Overspending, Oversocialization, and Over Religious)
• Grandiosity
• Flight of ideas
• Activity level(Very high)
• Sleep( decreased need for sleep)
• Talkativeness

Also Read: Schizoaffective Disorder: Causes, Symptoms, Diagnosis, Treatment and Complications

Bipolar II Disorder

• The prevalence of this disorder is higher in females and the mean age of onset is slightly higher.
• Hypomania symptoms are similar to mania but they are not severe enough to cause marked impairment of social and occupational functioning and also the patient does not have any psychotic symptoms. The duration is 4 days.

Diagnostic Criteria

• As per DSM 5, the first two symptoms that is mood elevation and increased energy along with three or more other symptoms for one week are required to diagnose a patient.
• Mania with psychotic symptoms
• Mania with delusion or hallucination

Treatment of Bipolar Disorder

For acute manic or hypomanic episodes when the patient comes into the elated mood the first step will be to stop the antidepressant and after that, the first-line drug that is lithium is prescribed. If the patient presents with signs of psychosis then antipsychotics like olanzapine and risperidone should be prescribed. The other drug that can be used for bipolar disorder is valproate.

Also Read: Depression - Symptoms, Causes, and Treatment - NEET PG Psychiatry

Mood Stabilizers

1. Lithium- the onset of drug action is within one to three weeks. It is not metabolized and is excreted through Kidneys. The side effects are Postural Tremors, Hypothyroidism, Diabetes incipidus, and acne. If lithium is taken during pregnancy it can lead to an Ebstein anomaly of tricuspid valve. The therapeutic range for lithium is 0.5-1.5 meq per liter. There is a risk of lithium toxicity if the dosage exceeds the recommended dose, renal impairment, or if there is any drug interaction present. The moderate symptoms of lithium toxicity are Anorexia, nausea, and vomiting. The severe symptoms are Generalized convulsion, renal failure, and death. The treatment of lithium toxicity is done by stopping lithium, correcting the hydration, and in severe cases, Hemodialysis is done.
2. Valproate- it has a rapid onset of action and better tolerability and it should not be given in hepatic disease. The side effect of valproate is polycystic ovarian disease in females. 
3. Carbamazepine
4. Lamotrigine can be used in bipolar depression.
5. In pregnancy, a correct choice of medication should be made because most of the drugs used to treat bipolar disorder are teratogenic. If there are severe symptoms of bipolar disorder, lithium and an antipsychotic can be prescribed. Lamotrigine is safer than valproate and carbamazepine.
6. For maintenance or prophylaxis (two or more episodes or after a single episode of mania) the treatment of choice is lithium and valproate and the minimum duration is 2 years.

Also Read: All About Panic Disorder and Phobias

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