bipolar%20disorder
BIPOLAR DISORDER
Bipolar I disorder is primarily defined by manic or mixed episodes that last for at least 7 days, or very severe manic symptoms needing immediate hospital care. The patient also has depressive episodes which may last for at least 2 weeks.
Bipolar II disorder is usually misdiagnosed. It is characterized by occurence of ≥1 major depressive episodes with at least 1 hypomanic episode.
Cyclothymic disorder or cyclothymia is a mild form of bipolar disorder. Patients have  episodes of hypomania alternating with mild depression that lasts for 2 years.
Rapid-cycling bipolar disorder patients have ≥4 episodes of major depression, mania, hypomania or mixed symptoms within a year.

Bipolar%20disorder Signs and Symptoms

Introduction

  • Mood disorder characterized by episodic, recurrent and frequently progressive condition of mania, hypomania and major depression
  • Age of onset is between 15 and 30 years old with overall average of 25 years old
  • An estimated 2.4% total lifetime prevalence reported by the World Mental Health Survey across bipolar I, bipolar II & subthreshold bipolar disorder subtypes
  • Associated with increased comorbidity with substance abuse, anxiety disorder, personality disorders and attention-deficit hyperactivity disorder (ADHD)
    • Comorbidity with axis I or axis II may be associated with an earlier age at onset and a worse course of illness

Bipolar Subtypes

Bipolar I

  • Primarily defined by manic or mixed episodes that last for at least 7 days, or very severe manic symptoms needing immediate hospital care
  • Patient also has depressive episodes that may last for at least 2 weeks

Bipolar II

  • Usually misdiagnosed; characterized by occurrence of ≥1 major depressive episodes with at least 1 hypomanic episode

Other Specified Bipolar and Related Disorder or Unspecified Bipolar and Related Disorder

  • Patient has symptoms that do not meet the criteria for either bipolar I or II
    • Symptoms may not last long or are very few

Bipolar Spectrum Disorders

Cyclothymic Disorder or Cyclothymia

  • A mild form of bipolar disorder
  • Patients have episodes of hypomania alternating with mild depression that lasts for 2 years

Rapid-Cycling Bipolar Disorder

  • Patients have ≥ 4 episodes of major depression, mania, hypomania or mixed symptoms within a year
  • More common in patients with severe bipolar disorder, in people who had the disease at an earlier age and in female patients

Signs and Symptoms

Clinical Course
  • Patient may present with bipolar disorder in a manic, hypomanic, depressive or mixed state
  • More common for 1st episode to present as depression
  • Often, the patient will suffer from a number of depressive episodes before a manic episode occurs
  • Features of bipolar disorder vary and can be traced by recording using daily mood chart
  • Patients with bipolar disorder have the highest risk for suicide
    • Knowing risk factors (eg younger age, male, unemployed, early onset of mood disorder) can help in detection of patients who are at risk for suicide

Depression

  • Depressive symptoms occur more commonly than manic symptoms throughout the course of illness
    • Bipolar I patients have depression 3 times more frequent than mania
    • Bipolar II patients experience depression 37 times more commonly than hypomania
  • Episodes of depression are similar to unipolar major depression
    • Bipolar depression occurs more commonly in patients with family history of bipolar disorder and in patients with early onset of depression
  • Subsyndromal episodes associated with loss of interpersonal skills andoccupational ability are common in patients with bipolar disorder

Mania

  • Extreme behaviors associated with manic episodes often require hospital admission to prevent harm to self and others
  • Acute phase of mania may involve extreme affect, often euphoric or irritable
  • Causes impairment in perception, somatic and social functioning

Hypomania

  • Also have features of mania but at a lesser extent, where insight is preserved
  • Usually accompanied by mild functional impairment
  • Can be assessed using the Hypomania Symptom Checklist (HCL-32), Mood Disorders Questionnaire (MDQ),Young Mania Rating Scale (YMRS)
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Psychiatry - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Audrey Abella, 5 days ago
A pilot telemedicine initiative may be an alternative for facilitating delivery of intravenous iron (IVI) for individuals requiring iron supplementation.