Bipolar disorder occurs in approximately 1 percent of the population. Bipolar II disorder and Bipolar disorder not otherwise specified (NOS) account for another 2.5 percent of the population. Bipolar disorder is almost always recurrent and can be associated with severe illness-related Morbidity and increased medical mortality. About 10 to 20 percent of patients with bipolar disorder die of their illness by suicide.
Bipolar disorder is equally prevalent in men and women. It has an early age onset. The most common age of onset of bipolar disorder is 1721 years. It is a highly disabling illness, and in fact a study.
Bipolar disorder is caused by bio psychosocial influences including genetic, perinatal, neuroanatomic, neurochemical and other biologic abnormalities. In addition psychological and socio environmental factors are associated with a greater risk of bipolar disorders. The role of genes in the susceptibility to mood disorders has long been supported by family, twin, and adoption studies. That mood disorders run in families is a common observation of patients and clinicians. However, genes clearly only contribute a predisposition that must interact with environmental factors in order to cause disease. Treatment of bipolar disorders requires an integration of medical, psychological, and psychosocial inputs.
Keywords: Bipolar; Mania; Hypomania; Cyclothymia; Mood Stabilizers; Psychotherapy;
Bipolar disorder is common and disabling . The hallmark of the disorder is mood elevation (mania or hypomania) . Patients with bipolar I disorder have episodes of mania and nearly always experience major depressive episodes. Patients with bipolar II disorder suffer both hypomanic episodes and major depressive episodes.
It is one of the most severe of the psychiatric disorders. Bipolar disorder is among the most disabling and economically catastrophic medical disorders, ranked by the World Health Organization as one of the common illnesses contributing to the global burden of disease .
It carries a lifetime risk of around 2.6–7.8%, and its early onset and tendency to chronicity mean that its prevalence is relatively high. The social and economic impact of the illness is enormous, and its impact on sufferers and their families can be devastating [4, 5].
Bipolar disorder is a clinical diagnosis. It must be differentiated from other psychiatric and medical illnesses, as well as from disorders such as heavy metal toxicity, adverse effects of drugs, and vitamin deficiencies .
Treatment of bipolar disorders requires an integration of medical, psychological, and psychosocial inputs. The bulk of care occurs in an outpatient setting and is best carried out by a multidisciplinary team. Psychosocial rehabilitation is an essential part of treatment .
Family Studies: Studies indicate that bipolar disorders run in families. First degree relatives of people with bipolar I disorder are approximately 7 times more likely to develop bipolar I disorder than the general population. Remarkably, offspring of a parent with bipolar disorder have a 50% chance of having another major psychiatric disorder. One longitudinal study found that sub threshold manic or hypomanic episodes were a diagnostic risk factor for the development of subsequent manic, mixed, or hypomanic episodes in the offspring of parents with bipolar disorder. In fact, unipolar disorder is typically the most common form of mood disorder in families of bipolar probands. However, the rate of bipolar disorder is only slightly elevated in the families of unipolar probands. This familial overlap suggests some degree of common genetic underpinnings between these two forms of mood disorder 
Twin Studies: Twins who are reared together share the same environment, but monozygotic (MZ) twins share all their genes, while Dizy Gotic (DZ) twins share on average only 50 percent. Twin studies compare the concordance rates in MZ and DZ twins. The concordance rate refers to the proportion of co-twins who are also affected or to the proportion of twin pairs where both twins are affected. Twin studies demonstrate a concordance of 3390% for bipolar I disorder in identical twins. As identical twins share 100% of their DNA, these studies also show that environmental factors are involved, and there is no guarantee that a person will develop bipolar disorder, even if they carry susceptibility genes [7, 8].
Adoption Studies: Adoption studies provide an alternative approach to separating genetic and environmental factors in familial transmission. Adoption studies have been conducted using a variety of experimental designs, but the most common is the adoptee as proband strategy. In this approach, probands are identified who have a mood disorder and were adopted at birth. Through this event, nature is separated from nurture. The rates of psychiatric illness are then determined in both the biological and adoptive parents. Numerous adoption studies prove that a common environment is not the only factor that makes bipolar disorder occur in families. Children whose biologic parents have either bipolar I disorder or a major depressive disorder remain at increased risk of developing an affective disorder, even if they are reared in a home with adopted parents who are not affected [7,8].
Linkage Studies: Numerous linkage studies of bipolar disorder have implicated many different chromosomal regions. Bipolar disorder, especially bipolar type I (BPI) disorder, has a major genetic component, with the involvement of the ANK3, CACNA1C, and CLOCK genes [9, 15]. The evidence indicating a genetic role in bipolar disorder takes several forms.
• Mood stabilizers
• Anti-anxiety medications
Most people with bipolar I or bipolar II will need mood stabilizers to control their manic or Hypomanic episodes. Commonly used moods stabilizers include:
• Tegretol (carbamazepine)
• Depakote (divalproex sodium., valproic acid)
• Lamictal (lamotrigine)
• Lithobid (lithium)
Antipsychotic drugs may also be used to control episodes of depression or mania, especially when delusions or hallucinations are occurring. Examples of drugs in this class include:
• Abilify (aripiprazole)
• Saphris (asenapine)
• Symbyax (olanzapine and fluoxetine)
DSM-V Diagnostic Criteria for bipolar I disorder
C. 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.
Note: Do not include symptoms that are clearly attributable to another medical condition.
Note: In children and adolescents, can be irritable mood.
Note: In children, consider failure to make expected weight gain.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
DSM-V Diagnostic Criteria for bipolar II disorder
DSM-V Diagnostic Criteria for Cyclothymic Disorder
Indications or preferred to use
Euphoric, pure(classic )mania, no psychosis, no rapid Cyclic previous good personal or family response and sequence of mania-depression-euthemia.
Irritable mania, mixed episode, rapid cycling, secondary mania, comorbid substance use, severe with psychosis
History of trigeminal neuralgia, comorbid post traumatic stress disorders, comorbid substance issues, Severe mania( with psychosis), comorbid anxiety and panic attack, commorbid migraine headache, Irritable mania
FDA approved for acute and maintenance treatment for mania.
• Zyprexa (olanzapine)
• Seroquel (quetiapine)
• Risperdal (risperidone)
• Geodon (ziprasidone)
An antidepressant may also be used to manage depressive episodes, in conjunction with a mood stabilizer or an antipsychotic.
Finally, Benzodiazepines Diazepam, Lorazepam, Clonazepam or another type of anti anxiety medication may be used.
Psycho education: Psycho educational interventions include any discrete programme involving interaction between an information provider and service users or their careers which has the primary aims of offering information about the condition and the provision of support and management strategies. Complex psycho education was defined as any group programme involving an explicitly described educational interaction between the information provider and the patient/carer as the prime focus of the intervention [47, 48]. Patients/carers should be provided with information, support and different management strategies, including: illness awareness, treatment compliance, early detection of prodromal symptoms and relapse, lifestyle regularity.
Cognitive behavioral therapy (CBT): A structured and collaborative therapeutic approach, CBT is a discrete psychological intervention which aims to make explicit connections between thinking, emotions, physiology and behavior with respect to current or past problems, primarily through behavioral experiments and guided discovery. CBT seeks to achieve systemic change through the reevaluation of perceptions, beliefs or reasoning thought to cause and maintain psychological problems. The aim is to help the individual normalize and make sense of their psychotic experiences, and to reduce the associated distress and impact on functioning. Targeted outcomes include symptom reduction, relapse reduction, enhancement of social functioning, development of insight, amelioration of distress, and the promotion of recovery [49, 50].
Family intervention: Family intervention is a discrete psychological intervention with a specific supportive, educational or treatment function which involves problem solving/crisis management and/or intervention with the identified service user. Family intervention for individuals diagnosed with bipolar disorder has developed out of the consistent finding that the emotional environment within a family was an effective predictor of relapse. In this context, ‘family’ includes people who have a significant emotional connection to the individual, such as parents, siblings and partners. Different models of family intervention aim to help families cope with their relative’s problems more effectively, provide support and education for the family, reduce levels of distress, improve the ways in which the family communicates and negotiates problems, and try to prevent relapse by the service user . Family sessions with a specific supportive or treatment function based on systemic, cognitive behavioral or psychoanalytic principles, which must contain at least one of the following psycho educational intervention, problem solving/crisis management work and intervention with the identified patient.
Interpersonal and social rhythm therapy (IPSRT):
Interpersonal and social rhythm therapy (IPSRT) was defined as discrete, time limited, structured psychological intervention derived from an interpersonal model of affective disorders [52, 53]. It focuses on:
• Working collaboratively with the therapist to identify the effects of key problematic areas related to interpersonal conflicts, role transitions, grief and loss, and social skills, and their effects on current symptoms, feelings states and/or problems
• Seeking to reduce symptoms by learning to cope with or resolve these interpersonal problem areas
Seeking to improve the regularity of daily life in order to minimize relapse.
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