bipolar affective disorder

bipolar affective disorder

1. Mental health nursing PRESENTED BY :- PATEL PRITESH D M.Sc.in Mental Health Nursing Bipolar disorder

2. Bipolar disorder Bipolar mood or affective disorder is characterized by recurrent episodes of mania and depression in the same patient at different times. Earlier known as manic depressive psychosis (MDP)

3. Definition :- Bipolar disorder , also known as manic- depressive illness , is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

4. Types Bipolar I: Characterized by episodes of severe mania and severe depression. Bipolar II: Characterized by episodes of hypomania (not requiring hospitalization) and severe depression.

5. Etiology Etiology is not known. Others ;- Genetic hypothesis Nuero –chemical factors Enviromental factors

6. Con.. 1.Genetic hypothesis The life-time risk for the first degree relatives getting bipolar disorder is 25%. Children with one parent having bipolar disorder has a risk of 27% of life time risk, children with both parents having bipolar disorder is 74%. The risk in monozygotic twins is 65% and dizygotic twins is 20%.

7. Con … 2. Nuero –chemical factors :- Brain chemicals called neurotransmitters convey messages between the nerves . Too many or too few neurotransmitters are believed to cause alterations in mood . drug like cocaine , which also act on this neurotransmitter system hormonal imbalances and disturption of the hypothalamia –pituitary –adrenal

8. Con … 3. Environmental factors :- stressful life events . disturbances in seasonal rhythms . sleep deprivation treatment whith antidepressants and certain herbal and dietary supplements . nature of their work pregnancy

9. Clinical features Depression Form : constantly feeling sad or worthless sleeping too much or too little feeling tired and having little energy appetite and weight changes problems focusing thoughts of suicide Manic Form : increase in energy level less need for sleep easily distracted nonstop talking increased self confidence focused on getting things done, but does not accomplish much is involved in risky activities even though bad things may happen

10. Con .. A current episode can be Hypomanic Manic without psychotic symptoms Manic with psychotic symptoms Mild or moderate depression Severe depression without psychotic symptoms Severe depression psychotic symptoms

11. Dignosis :- Physical exam.  Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms. Psychiatric assessment.  Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.

12. Con .. Mood charting.  You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment. Criteria for bipolar disorder.  Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

13. Management Antidepressants ECT Lithium Antipsychotics Other mood stabilizers

14. Reduce the symptoms of mania Reduce the symptoms of bipolar depression Prevent the recurrence of a manic or depressive episode Avoid or minimize adverse treatment effects Improve quality of life Mood stabilizing agents are the cornerstone of treatment. Complete assessment and careful diagnosis to rule out non-psychiatric causes. Treatment is lifelong.  

15. Con… Interpersonal, family and group therapy. Cognitive-behavioral therapy (CBT). Electroconvulsive therapy (ECT). Psychoeducation .

16. Mood-stabilizing drugs are the usual first-choice treatments and include lithium, divalproate , carbamazepine .   Atypical antipsychotics other than clozapine are also approved for treatment of acute mania Lithium, lamotrigine , olanzapine , and aripiprazole are approved for maintenance therapy. Benzodiazepines are used for mania. Antidepressants may be used for bipolar depression, but usually along with a mood-stabilizing agent to prevent a mood switch to mania. Mood-stabilizing drugs are considered the primary pharmacotherapy for relapse prevention.

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