Download Bipolar Disorder Discussion

Bipolar Disorder Discussion
Dr Christo du Plessis
Psychiatrist
23 May 2014
Bipolar Disorder - Definition
• Mood disorder
• In life:
≥1 manic / hypomanic episode
≥1 depressed episodes
Bipolar Disorder - Definition
• Characterised by
– MOODSWINGS
– Impaired functioning
Bipolar Disorder - Definition
• Types:
– Bipolar I
– Bipolar II
– Mixed episodes
– Rapid cycling
1y
– Bipolar with psychosis
Symptoms
MOOD
COGNITION
MANIA
Elevated
Irritable
Euphoria
Poor concentration
Distractable
Poor judgement
DEPRESSION
Depressed
Poor concentration
Sad
Memory impairment
Hopeless
Difficult to make decisions
Guilt
Worthless
Helpless
Decreased pleasure experience
Symptoms
THOUGHTS
HYPOTHALAMIC
BEHAVIOUR
MANIA
Racing
Fast speech
Unrealistic beliefs
(own abilities,
powers, etc.)
↓ insight
Increased energy
Decreased need for
sleep
Spending
Phone calls
Increased sexdrive
Substance abuse
High risk behaviour
Psychosis
DEPRESSION
Death ideation
Suicide ideation
Low energy
Fatigued
Sleep ↑↓
Appetite↑↓
Weight↑↓
Withdrawn
Lethargic
INSIGHT
COURSE: CHRONIC
• NO TREATMENT:
– Get worse
• TREATMENT:
– ↓ frequency and intensity
DIFFERENTIAL DIAGNOSIS
•
•
•
•
Depression
ADHD
Personality Disorders
Schizophrenia
EPIDEMIOLOGY
• 1-3/100 people
• Start:
10y
20y
30y
40y
• Cause:
–
–
–
–
?
Genetic factors
External stressors
Sleep disturbances (Shiftwork)
50y
EPIDEMIOLOGY
Comorbid disorders:
• Psychiatric:
– Anxiety
– Substance abuse
– Impulse control disorders
• General Health:
–
–
–
–
–
Obesity
Reduced exercising
Smoking
DM
Increased bloodpressure
TREATMENT
1. Diagnosis
Need to make propper diagnosis – correct treatment
Be careful: Dx for MA – problems with life insurance
2. Psychologist
Help understand diagnosis
ID triggers
Info to patient / Support
3. Dr/Psychiatrist
Diagnosis
Treatment
ECT
4. Supportgroup
Spouse / Family
Friends
Psychiatric team
OT
MEDICATION
• MOODSTABILISERS
1. Lithium
1. Gold standard
2. Needs monitoring
3. SE: Thyroid, kidneys, Nausea, GIT, Obesity
2. Anticonvulsants
1. Valproate (Epilim, Navalpro, Epilizine)
2. Carbamazepine (Tegretol, Degranol)
3. Lamotrigine (Lamictin, Lamitor, Epitec)
MEDICATION
• ANTIPSYCHOTICS
1. First Generation
1.
2.
3.
Haloperidal (Serenace)
Flupenthixol (Fluanxol)
Chlorpromazine (Largactil)
2. Second Generation
1.
2.
3.
4.
5.
Quetiapine (Seroquel, Truvalin, Dopaquel)
Risperidone (Risperdal, Risperlet)
Olanzapine (Zyprexa, Oleans, Prexalon)
Aripiprazole (Abilify)
Ziprasadone (Geodon)
MEDICATION
• BENZODIASEPINES
1. Use for short period
2. SE:
1.
2.
3.
Addiciton
Poor concentration
Memory loss
3. E.g.:
Diasepam (Valium, Pax, Betapam)
Clobazam (Urbanol)
Loprazolam (Dormonoct)
Clonazepam (Rivotril)
Alprazolam (Alzam, Xanor, Zopax)
MEDICATION
• ANTIDEPRESSANTS
1. SSRI
1.
2.
3.
Fluoxetine (Prozac, Nuzak, Lorien)
Sertraline (Zoloft, Serdep, Serlife, Zertra)
Fluvoxamine (Luvox, Faverin)
2. SNRI
1.
2.
Duloxetine (Cymbalta, Cymgen, Yelate)
Venlafaxine (Effexor, Venlor)
3. MELATONIN DERATIVE
1.
Agomelatine (Valdoxane)
4. TRICYCLICS
1.
2.
Amitriptyline (Trepilin, Tryptanol)
Clomipramine (Anafranil, Clomidep)
5. NDRI
1.
Bupropion (Wellbutrin)
6. OTHER
1.
Mirtazapine (Remeron, Adco-Mirteron, Beron)
• ECT
MEDICATION
– Only in severely resistant manic cases
RECOMMENDATIONS
1.
2.
3.
4.
5.
6.
7.
8.
Take responsibility
Regular visits
Bloodtests
Know your medication
Monitor SE
Don’t run out of medication
Plan ahead if you go away
Keep a mood diary