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106 articlesPage 5 of 9
A. Biomedical Therapies: Treatment of bi-polar disorder depends on the specific form of be-havioral disorder at presentation. Lithium carbonate or divalproex represents the preferred initial intervention for the acute manic state, even though 10-14 days may be required before full
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A 27-year-old male graduate student in molecular biology was brought to the emergency room by his fiancee, who explained that over the preceding 2 weeks he had become increasingly irritable and suspicious and had undergone a “personality change.” She noted
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Multinational studies indicate that the lifetime risk of bipolar disorder is approximately 1-2%. Depending on how the phenotype is defined, the concordance rate for bipolar illness ranges from 65% to 85% in monozygotic twins and is 20% in dizygotic twins.
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A. Biochemical Factors: Although many differences in biochemical indices have been described when patients with bipolar disorder are compared to normal control subjects, there is no agreement about which alterations have etiological significance and which are secondary effects or epiphenomena.
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Emil Kraepelin, the German psychiatrist who coined the phrase “manic depression,” wrote that bipolar illness, in contrast to schizophrenia, usually has a good prognosis. In Kraepelin’s original sample of 459 patients, 45% had only one attack, and very few had
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A. Manic Disorder: Now that pharmacological treatment has become widespread, the complete natural history of a manic episode is seldom observed. Speed of onset, severity, and duration of the manic episode vary greatly in different individuals, depending, apparently, in part
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Manic symptoms can occur in association with known organic disorders, but in such cases should be diagnosed as a mood disorder due to a general medical condition (ie, “secondary mania”) rather than as bipolar disorder. There appear to be no
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One essential criterion for a diagnosis of bipolar I disorder is a past or present history of a manic episode. Manic episodes are characterized by a predominantly elevated, expansive, or irritable mood that presents as a prominent or persistent part
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Women who wish to have a baby should have at least 2 yr of maintenance therapy with no episodes before a lithium holiday is prescribed. Lithium is discontinued in the 1st trimester to avoid the risk of Ebstein’s anomaly, a
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Acute management: Classic euphoric mania often presents as a social emergency and is preferably managed on an inpatient basis. Lithium works best in uncomplicated euphoric mania. After baseline laboratory tests (CBC, urinalysis, thyroxine, TSH, serum electrolytes, creatinine, and BUN) are
9 min read
Prevention of rapid cycling: Antidepressants may induce rapid cycling in some patients (eg, patients with bipolar II disorder and a cyclothymic temperament), even when given with lithium. The best strategy is preventive: limiting the use of antidepressants during the depressive
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Symptoms of the depressive phase are similar to those of unipolar depression (see above), except that psychomotor retardation, hypersomnia, and, in extreme cases, stupor are more characteristic. In full-blown manic psychosis, the mood is usually elation, but irritability and frank
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