Topic Whatisbipolardisorder?

Diagnosticcriteria Subtype

Whatdoesitlooklike? Prevalence,course, Comorbidpersonality,substance Dangerousnesssuicide,violence

Howtotreat? Treatmentdrugs,psychotherapy Prognosis

What is Bipolar Disorder ? It is a spectrum of

affective episodes including: Major depressive

episode Manic episode Mixed episode Rapid cycling Hypomanic episode

The DSM-IV categorizes it into:

Bipolar I Disorder Bipolar II Disorder Cyclothymia Bipolar N.O.S.

unipolar disorder?unipolar disorder?

Polarity Manic Hypomanic Mixed

Majordepressive Minordepressive dysthymia

()

(+,no manic or mixed episode)

N.O.S.

(+)

Rapid cycling 4

1.

2.

3.

4.

5.

6.

7. ()

Manicepisode Chiefproblems

Presentillness

()

?

Manicvs.Hypomanicepisode

Diagnostic Diagnostic criteriaat least one at least one manicmanic or or mixedmixed episodeepisode

manic

hypomanic

Normal

Minor dep.

Major dep.

(1)(2)

296.0x

296.40

296.4x

296.5x

296.6x

296.7

Criteriaat least one major dep. + hypomanic episode

manic

hypomanic

Normal

Minor dep.

Major dep.

20 (1525) >

??

PrevalenceRatesandCourse

BipolarI Lifetime:1%(0.4 1.6%) men=women Men:moremanicepisodes Women:moredep.episodes Women:morerapidcycling (5 15%) Ave.ageonset=20(15 25) Recurrent 60 70%ofmanicepisodesoccurbeforeorafteradepressiveepisode

PrevalenceRatesandCourse BipolarII

Lifetime:0.5% Maybemorecommoninwomen thanmen Men:morehypomanicthandepressiveepisodes Women:moredepressivethanhypomanicepisodes Women:morerapidcycling 60 70% ofhypomanicepisodesoccurbeforeorafteradepressiveepisode

Intervalbetweenepisodesdecreasewithage Lessdataoverall

CyclothymicDisorder

hypomanic+minordepressivesymptoms2 2months

Lifetime:0.4 1% Men=Women Onsetadolescenceorearlyadulthood 15 50%riskofdevelopingintoBipolarDisorder

Cyclothymicdisorder

BipolarDisorderN.O.S. Rapidcycling(days)betweenmanicanddepressivesymptoms

Recurrenthypomanicepisodeswithoutintercurrentdepressivesymptoms

Hypomanicepisodes,alongwithchronicdepressivesymptoms,thataretooinfrequenttoqualifyforadiagnosis

Etiological Factors Hereditary Factors

(5~15%) vs. (0.5~1.5%) (60~80%) vs.(20~30%)

Biochemical Hypothesis Dopamine, norepinephrine, serotonine

Stressful Life Events Cognitive Styles as Vulnerabilities

Prognosticfactorsofbipolardisorder

1. Suicidality2. Presenceofapersonalitydisorder3. Qualityoffamilyandsocialsupport4. Substanceuse5. Historyofseverityofpriorepisodes6. BipolarItypeismostsevere7. Treatmentonsetthesoonerthebetter8. Ageofonsettheyoungerthemoresevere

SUICIDERISK

:10 15%(suicideattempt:25~50%) Presenceofsuicidalorhomicidalideation,intent,plans Accesstomeans Psychoticfeatures,severeanxiety Substanceabuse Historyofpreviousattempts Familyhistoryorrecentexposure

SubstanceAbuseandBipolarDisorder

B.D.: B.D.:21 61%

: 3 13% B.D. antisocialpersonalitydisorderintermsofconcurrentsubstanceabuse

Substanceuse

BipolarDisorderandPersonalityDisorders

50% personalitydisorder clusterBandC ClusterB: Antisocial,Borderline,Histrionic,Narcissistic

ClusterC: AvoidantandObsessiveCompulsive

Overalleconomicburdenisestimatedat$45billiondollarsannually

Costsoftreatmentforanindividualexceed$17,000peryear

1in3peoplewithbipolardisorderfailtocomplywithmedications

Nonadherencetotreatmentoftenresultsinhospitalizationandsuicide

1. Lithium

2. Valproate PCO

3. Olanzapine

4. Lamotrigine - SJS

+ ?

(1)

(2)?

26

:

8

? ?252

() 20 60

:

*:

Family interventionPEACE

P =Problem solving E =Education A =Acceptance C =Communication E =Escape