group 4M. .pptx

Mental health

1. GROUP 4 MENTAL HEALTH BIPOLAR AND RELATED DIORDERS

2. objectives At the end of this session students should be able to describe bipolar and related disorders

3. INTRODUCTION Bipolar disorder is the mental health condition that causes extremely mood swings includes emotional highs( mania or hypomania) and lows(depression) Diagnostic disorder for bipolar disorder 1,it is necessary to meet the following criteria for a manic episode .the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

4. MANIC EPISODE A distinct of abnormally and persistently elevated ,expansive or irritable mood and abnormally and persistently increased goal directed activity or energy lasting atleast 1 week and present on most of the day nearly everyday Symptoms Inflated self esteem Decreased need for sleep More talkative than usual distractibility

5. 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 The episode is not attributable to the physiological effects of a substance example drug abuse, medication or other treatment as a full manic episode that emerge during antidepressant treatment. All criteas are constitute manic episode but atleast one lifetime manic episode is required for the diagnosis of bipolar 1

6. HYPOMANIC EPISODE A distinct period of abnormally and persistently elevated,expansive,or irritable mood and abnormally and persistently increased activity or energy lasting atleast 4 consecutive days or present most of the day nearly everyday The disturbance in mood and change in functioning are observed by others Other symptoms are similar to those in manic episode though in hypomania is a milder version of mania that typically lasts for a shorter period.

7. MAJOR DEPRESSIVE EPISODE Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day to day activities such as work , school,social activities or relationships. Symptoms Depressed mood,such as feeling sad,empty,hopeless or tearful,depressed mood can occur. Marked loss of interest or feeling no pleasure in almost all activities. Significant weight loss when not dieting,weight gain or decrease or increase in appetite.

8. Fatigue or loss of energy Feeling worthlessness or excessive or inappropriate guilt Thinking about ,planning or attempting suicide. The symptoms causes clinically significant distress or impairment in social,occupational or other imporntant functioning. The episode is not attributable to the physiological effects of substance abuse or other medical condition .

9. CODING AND RECORDING PROCEDURES The diagnostic code for bipolar is based on type of current or most recent episode and its status .current severity and psychotic features and reemission status . Current severity and psychotic features are only indicated if full criteria are currently met for manic or major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a manic, hypomanic or major depressive episode.

10. DIAGNOSTIC FEATURES During manic episode,the individual may engage in multiple overlapping new projects. Inflated self-esteem is typically present ranging from uncritical self-confidence to marked grandiosity and may reach delusional propotion. Decreased need for sleep. Speech can be rapid,pressured,loud or difficult to interrupt.

11. The increase in goal directed activity often consist of excessive planning and participation inmutiple activities including sexual,occupational . Mood in manic episode is often described as euphoric,excessively cheerful,high or feeling on top of the world.

12. PREVELENCE The 12-month prevalence estimate in the continental United States was 0.6% for bipolar I disorder as defined in DSM-IV. Twelve-month prevalence of bipolar I disorder across 11 countries ranged from 0.0% to 0.6%. The lifetime male-to-female prevalence ratio is ap­proximately 1.1:1.

13. Developmental and course Mean age at onset of the first manic, hypomanie , or major depressive episode is approxi­mately 18 years forbipolar I disorder. Special considerations are necessary to detect the di­agnosis in children. Since children of the same chronological age may be at different developmental stages, it is difficult to define with precision what is ''normal" or "ex­pected" at any given point.

14. Cont …. Therefore, each child should bejudged according to his or her own baseline. Onset occurs throughout the life cycle, including first onsets in the 60s or 70s. Onset of manic symptoms (e.g., sexual or social disinhibition) in late mid-life or late- life should prompt consideration of medical conditions (e.g., frontotemporal neurocogni - tive disorder) and of substance ingestion or withdrawal.

15. More than 90% ofindividuals who have a single manic episode go on to have recurrent mood episodes. Approximately 60% of manic episodes occur immediately before a major depressive episode. Individuals with bipolar I disorder who have multiple (four or more) mood episodes (major depressive, manic, or hypomanie ) within 1year receive the speci­fier "with rapid cycling

16. RISK AND PROGNOSTIC FEATURES. RISK FACTORS . Genetic predisposition ; this means children born with parents having history of the disease are four or six times more likely to develop the disease more than those children who do not have family history of the bipolar disorder. Environmental triggers; the stressful life events, substance abuse and sleep distractions can contribute to the disorder. Biochemical factors ; brain structure and brain chemistry play a role as imbalances in certain neurotransmitters such as serotonin and nor epinephrine have been linked to manic and depressive episodes.

17. PROGNOSTIC FEATURES . Recurrent manic and depressive episodes Mania: an elevated or euphoric mood or irritable state that is characterized by bipolar 1 disorder, this state is characterized by mental and physical hyperactivity, disorganization of behaviour and inappropriate elevation of mood. Mania might sound as if it would feel good but it is in fact a painful, pressured feeling that is not all pleasurable. Hypomanic episodes: is similar to manic but less severe, it does not cause significant impairment in social or occupational functioning its symptoms includes increased energy and activity, euphoria and impulsive behaviours.

18. Depression: This is a mental state characterized by excessive sadness, individual in the depressed mood state experiences loss of interest in activities and people also loss of appetite ,difficulty sleeping lack of sexual desire even to libido and an extremely loss of general energy, their ability to think and concentrate is also compromised. Mixed episodes. Bipolar disorders are characterized by one or more manic episodes which are so called mixed episodes which involve both manic and depressive feeling alternating rapidly, often within same day or week. Also may experience one or more major depressive episodes, this condition sometimes lead to irritability and agitation and difficult in sleeping.

19. Psychotic symptoms. in some cases bipolar disorder can cause hallucinations and delusions. Increase risk of suicides This occurs due to experience of one or more major depressive episodes, suicides ideations and attempt may occur and about 10-15% of individuals with this disorder are at risk of suicides such as homicides.

20. Impact on relationships and employment. Individual with the disorder might experience interpersonal difficulties and occupational instability, whereas work, social and family relationship is impaired, feeling of worthlessness and helplessness are common and may or may not report feeling down or depressed the feeling they do experience are painful.

21. Comorbidity Refers to association or presence of two or more disorders in the same patient, this may share or reinforce some of its symptoms this includes the substance use disorder and anxiety disorders and many more others such as ADHD ( attention deficit /hyperactivity disorder). This conditions may worsen symptoms and complicate treatment, also increase distress and impairment.

22. Culture related diagnostic issues Culture factor scan influence how individuals perceive and describe their symptoms as well as affect the family dynamic and social support system, this includes; Symptom expression, for example in some cultures mood disturbance may be expressed somatically rather than verbally. Stigma and shame, associated with psychiatric disorders may lead individuals and families to avoid seeking professional help or disclosing symptoms.

23. Spiritual and religion; these may influence coping mechanism and treatment preferences some culture may incorporate religious or in spiritual lens. Access to care; due to socioeconomic factors, discrimination, and cultural mistrust may limit access to care. Cultural competence Family dynamics Language and communication

24. Gender related diagnostic issues. Gender can influence the presentation and diagnosis of bipolar 1 disorder; Research suggests that women with bipolar disorder are may experience more depressive episodes rapid cycling and mixed episodes compared to men. Women maybe likely to receive a misdiagnosis of depression or anxiety before being correctly diagnosed with bipolar disorder. For example hormonal fluctuations during menstrual cycles and pregnancy impact symptoms and severity and treatment response in women.

25. Therefore it is essential for the healthcare professionals to consider these gender specific factors when assessing and treating individuals with bipolar disorders.

26. Functional consequences of bipolar 1 disorders . The consequences can vary in severity this includes; Occupational impairment. Social and interpersonal challenges Financial instability Education disruption Health complications due to poor self care during depressive episodes. Impact on family due to mood instability, unpredictable behaviours and stress on how to manage the disorder.

27. Differential diagnosis of bipolar 1 disorder This involves distinguishing it from other conditions that may present with similar symptoms; Major depressive disorder(MDD) Bipolar 1 disorder can be misdiagnosed with MDD especially when there hasn’t been a manic or hypomanic episodes yet. Borderline personality disorder(BPD) Both involves the mood instability and intense emotions though in bipolar 1 disorder is characterized by distinct mood episodes such as mania, hypomania and depressive.

28. Schizoaffective disorder This disorder can include the psychotic symptoms( hallucination and delusions) and mood episodes in which the bipolar 1 disorder individual experiences also, therefore it is difficult to distinguish it from the bipolar 1 disorder since psychotic symptoms can also occur during manic and depressive episodes.

29. Attention deficit/ hyperactivity disorder(ADHD) The disease can present with hyperactivity, distractibility and sometimes overlap with other bipolar symptoms especially during manic or hypomanic episodes, however the distinct mood episodes helps to differentiate it.

30. Cont.. Other psychiatric disorders such as anxiety disorder. Substance use disorder Medical conditions such as thyroid disorders or neurological conditions

31. Bipolar II disorder is a mental health condition characterized by recurring episodes of depression and hypomania. Unlike Bipolar I disorder, which includes full-blown manic episodes, Bipolar II involves less severe hypomanic episodes. Here’s a detailed overview of Bipolar II disorder, including symptoms, diagnosis, and treatment:

32. Symptoms Hypomanic Episodes: Elevated Mood: Periods of noticeably elevated or irritable mood lasting at least four days. Increased Energy: Unusual levels of energy, activity, or restlessness.

33. Decreased Need for Sleep: Feeling rested after only a few hours of sleep. Grandiosity: Inflated self-esteem or an unrealistic sense of superiority. Talkativeness: Increased talkativeness or pressure to keep talking. Racing Thoughts: Rapid thought patterns and difficulty concentrating. Distractibility: Easily distracted by irrelevant stimuli. Risky Behaviors: Engaging in activities with potential for painful consequences, such as impulsive spending or unwise business investments.

34. Depressive Episodes: Persistent Sadness: Feelings of sadness, emptiness, or hopelessness. Loss of Interest: Diminished interest or pleasure in most activities. Changes in Appetite: Significant weight loss or gain unrelated to dieting. Sleep Disturbances: Insomnia or excessive sleeping. Fatigue: Loss of energy or increased fatigue. Feelings of Worthlessness: Excessive guilt or feelings of worthlessness. Cognitive Issues: Difficulty concentrating, making decisions, or thinking clearly. Suicidal Thoughts: Recurrent thoughts of death or suicide .

35. Diagnosis Criteria: Duration: Hypomanic episodes must last at least four days, and depressive episodes must last at least two weeks. Impairment: Symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning. Exclusion: The mood episodes are not better explained by another mental health condition, substance abuse, or medical condition.

36. Associated Features Supporting Diagnosis: Hypomanic episodes: Elevated mood, increased energy, and impulsivity lasting at least 4 days. Major Depressive Episodes: Persistent low mood, loss of interest, and other depressive symptoms lasting at least 2 weeks. Cyclothymic Disorder: Chronic mood fluctuations between hypomania and mild depression for at least 2 years.

37. Prevalence Bipolar II disorder is less common than Bipolar I but still significant. Estimated prevalence varies but is generally around 0.5% to 2.5% of the population.

38. Gender-Related Diagnostic Issues : • Some evidence suggests that Bipolar II disorder may be more common in women. •Women may experience more depressive episodes while men may have more frequent and severe manic episodes.

39. Development and Course : Typically begins in late adolescence or early adulthood. Often misdiagnosed initially as unipolar depression due to the predominance of depressive symptoms . Can have a chronic course with recurrent episodes interspersed with periods of euthymia .

40. Risk and Prognostic Factors • Family history of bipolar disorder or depression increases risk. •Substance abuse and stressful life events can trigger episodes. •Comorbidities like anxiety disorders and ADHD may complicate the course

41. Suicide Risk: • Individuals with Bipolar II disorder are at higher risk for suicide attempts compared to the general population. •Risk factors include severity of depressive symptoms, comorbid substance abuse, and previous

42. FUNCTIONAL CONCEQUENCES OF BIPOLAR II DISORDER Although many people with bipolar II disorder return to full functional level, atleast 15% continue to have some inter-episode disfunction and 20% change directly into another mood episode without inter-episode recovery. Functional recovery lags substantially behind recovery from symptoms of bipolar II diasorder , it delays occupational recovery lead to low socioeconomic status despite equal education level to general population .

43. People with bipolar II disorder perform poorly on cognitive test compared to health individuals with exclusion of memory and sematic fluency. They have same cognitive impairment as those with bipolar I disorder. Cognitive impairment associated with bipolar II disorder can lead to vocational difficulties. Prolonged unemployment in people with bipolar II disorder is associated with

44. Older age More episodes of depression Higher rate of current panic disorder Lifetime history of alcohol use disorder

45. DIFFERENTIAL DIAGNOSIS OF BIPOLAR II DISORDER Major depression disorder Cyclothymic disorder Schizophrenia spectrum and othe related psychotic disorder Panic disorder or other anxiety disorder Substance use disorder Attention- deficity / hyperactive disorder Personality disorders

46. COMORBIDITY Approximately 60% of individuals with bipolar II disorder have three or more co-occurring menta l disorders; 75% have an anxiety disorder; and 37% have a substance use disorder. Children and adolescents with bipolar II disorder have a higher rate of co-occurring anxiety disorders compared with those with bipolar I disorder, and the anxiety disorder most often predates the bipolar disorder.

47. Cont... Anxiety and substance use disorders occuring individuals with bipolar II disorder at a higher rate than in the general population. Ap proximately 14% of individuals with bipolar II disorder have at least one lifetime eating disorder, with binge -e ating disorder being more common than bulimia nervosa and anorexia nervosa.

48. Cont... These commonly co-occurring disorders do not seem to follow a course of illness that is truly independent from that of the bipolar disorder, but rather have strong associations with mood states. For example, anxiety and eating disorders tend to associate most with depressive symptoms, and substance use disorders are moderatel y associated with manic symptoms

49. TREATMENT AND MANAGEMENT The management and treatment of bipolar disorders include combination of medication, psychotherapy and life style changes and support network ; Medication; mood stabilizers such as lithium ,carbamazepine and valproic acid , antipsychotic medication such as olanzapine ,risperidone, quetiapine , antidepressants may be used but cautiously in a combination with mood stabilizers

50. Psychotherapy Cognitive behavioral therapy can also help to identify and change negative thoughts patterns and behavior , manage stress and improve communication skills . Interpersonal and social rhythm therapy can help individual with bipolar disorder to establish regular sleep patterns , exercise and other activities

51. life style changes Practicing good sleep pattern ,eating a healthy diet avoiding drugs and alcohol and regular exercises can help to stabilize mood and reduce symptoms support network , encourage individual to build strong support and network of friends ,family ,or peer support groups can help manage disorder .

52. Refernces DSM 5 2013 Mastering psychiatry 2015 Clinical practice Guidlines for management of bipolar disorder www.ncbi.nlm.gov

53. Participants JUSTINE MBENI LIDYA JOHN MAGRETH MHIZI JENIPHER FEDERIKA KITALUKA FLORENTINA ILUMBA OLIVER MBESI