Bipolar-type one

Characteristics

>extreme mood swings

>range from extreme highs (mania) to extreme lows (depression)

Causes/Triggers

>genetic/physiological factors i.e. chemical imbalance

>environmental factors, i.e. stress and triggering events that stimulate an inherited predisposition to
bipolar one
> experience of a manic episode (a distinct period during which there is an abnormally, persistently
elevated, expansive, or irritable mood and persistently increased activity or energy that is present) for most
of the day, nearly every day, for a period of at least 1 week, (or any duration if hospitalization is necessary),
accompanied by at least
three
additional symptoms from Criterion B. If the mood is irritable rather than
elevated or expansive, at least four Criterion B symptoms must be present.
(
Criteria B see last page)
>the mood disturbance is sufficiently severe to cause marked impairment in social or occupational
functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic
features.
>The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment) or to another medical condition.

DSM V classificatory criteria

Differential Diagnosis

>
Major Depressive Disorder
-
fewer symptoms/experienced for a shorter duration than required for mania
>
Other bipolar disorders
-
differentiation from bipolar 2 is determined by whether theres been any previous
episodes of mania, if not- bipolar type 2
>
GAD
/
other anxiety disorders
-
exploring previous symptoms carefully is needed to differentiate GAD from
bipolar disorder, i.e. anxious ruminations may be mistaken for racing thoughts
>
ADHD
-
symptoms overlap with the symptoms of mania, such as rapid speech, racing thoughts, less need for
sleep

>
Personality Disorders
-
symptomatic overlap with bipolar disorders, since mood lability and impulsivity are
common in both conditions

Medication

Medication Mechanism

Medication Contra-indications

Medication side-effects

DSM V Criteria (continued)

>Lithium
>Divalproex sodium
>Carbamazepine
>Lithium-
mood stabilizing effects
>Divalproex sodium-
an anticonvulsant (anti-seizure) drug also used to treat mania and to help prevent
migraine headaches
>Carbamazepine-
decreases nerve impulses that cause seizures and pain

.
>Lithium-
contraindicated in patients with renal failure, cardiovascular insufficiency, Addisons disease and

untreated hypothyroidism
,
can be harmful to pregnancy
>Divalproex-
contraindicated in patients with hepatic disease or significant hepatic dysfunction, urea cycle

disorders and hypersensitivy to drug

,
can be harmful to pregnancy
>Carbamazepine-
contraindicated in patients who have had an allergic reaction to a tricyclic antidepressant,
or a bone marrow disease or a history of bone marrow suppression, can be harmful to pregnancy
>Lithium-
lethargy, dysphoria, mental confusion, loss of interest in communicating with others
>Divalproex-
mild drowsiness, hair loss, vision changes, diarrhea, weight changes
>Carbamazepine-
dizziness, drowsiness, nausea, dry mouth, loss of balance

B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only
irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments).