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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risk behaviour Psychosis DEPRESSION Death ideation Suicide ideation Low energy Fatigued Sleep ↑↓ Appetite↑↓ Weight↑↓ Withdrawn Lethargic INSIGHT COURSE: CHRONIC • NO TREATMENT: – Get worse • TREATMENT: – ↓ frequency and intensity DIFFERENTIAL DIAGNOSIS • • • • Depression ADHD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