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Bipolar mood disorder

Introduction

Bipolar mood disorder is a lifelong illness, which may have an episodic, variable course. The presenting episode may be manic, hypo manic, depressive or mixed. By definition, a diagnosis of bipolar disorder requires either a current or previous episode of mania or hypomania. Bipolar disorder causes substantial psychosocial morbidity, frequently affecting patients’ relationships within the family as well as their occupation and other aspects of their lives

Risk Factors

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Signs and symptoms

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Diagnostic criteria

• An episode of mania is typically characterised by:
• Elevated mood /extreme happiness
• Irritability
• Increased energy/activity
• Talkativeness
• Reduction in the need for sleep
• Grandiose and/or religious delusions

Investigations

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Managemet

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  • Non-pharmacological

    • Hospitalisation may be required during acute mania
    • Psychotherapy, usually after the manic episode has been controlled with medication
    • Family therapy and psycho-education of patient and family to increase compliance and knowledge of the condition
    • In severe cases, psychiatrist directed electroconvulsive therapy may be required.

  • Pharmacological

    For Manic or Mixed Episodes

    For agitated and acutely disturbed patient: See section on aggressive disruptive behaviour.

    Maintenance therapy

    • Sodium valproate 20 mg/kg/day (PO) in 2–3 divided doses
    OR
    • Carbamazepine 600mg (PO) daily, increase by 200mg at three day interval up to a maximum of 2000mg
    OR
    • Lithium carbonate 400–1000mg (PO) as a single dose or in 2 divided doses. Elderly 400mg daily

    Note: Consider oral haloperidol with adjunctive benzodiazepines in patients who are difficult to manage, i.e. not settling with mood stabiliser monotherapy, and especially where there are features of psychosis.

    Treatment for Severe Depressive Episodes in Bipolar Patients

    Give antidepressant in combination with mood stabilizer and antipsychotic if there is psychosis:

    Drug of choice:

    • Amitriptyline 50mg nocte daily
    AND
    • Carbamazepine 300mg twice a day
    AND
    • Haloperidol 3–4.5 mg 12 hourly (if there is psychosis)

    Note: Do not use monotherapy antidepressants in bipolar patients.

Prevention

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Updated on,

20 Novemba 2020, 18:00:45

References

    1. STG
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