Bipolar disorder

Bipolar disorder or manic depression

It consists of episodes when the patient has mania (bipolar I) or hypomania (bipolar II) against a background of depression.

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania.

To be considered mania, the elevated, expansive, or irritable mood must last for at least one week and be present most of the day, nearly every day.

To be considered hypomania, the mood must last at least four consecutive days and be present most of the day, almost every day.

During this period, three or more of the following symptoms must be present and represent a significant change from usual behavior:

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Increased talkativeness
4. Racing thoughts
5. Distracted easily
6. Increase in goal-directed activity or psychomotor agitation
7. Engaging in activities that hold the potential for painful consequences, e.g., unrestrained buying sprees

The depressive side of bipolar disorder is characterized by a major depressive episode resulting in depressed mood or loss of interest or pleasure in life. The DSM-5 states that a person must experience five or more of the following symptoms in two weeks to be diagnosed with a major depressive episode:

1. Depressed mood most of the day, nearly every day
2. Loss of interest or pleasure in all, or almost all, activities
3. Significant weight loss or decrease or increase in appetite
4. Engaging in purposeless movements, such as pacing the room
5. Fatigue or loss of energy
6. Feelings of worthlessness or guilt
7. Diminished ability to think or concentrate, or indecisiveness
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt

Investigations

FBE

U & E

LFT

TSH

CT brain of any first episode psychosis associated with it

Management

Refer to psychiatrist

Outpatient or inpatient treatment  and voluntary or involuntary admission depends on the risk associated  and assessment

Mood stabilizers  such as

Epilim

Seroquel

Lithium