Bipolar Affective Disorder( updated Oct 2006)

 
Bipolar disorder is a major psychiatric illness characterised by periods of either elevated or depressed mood. Behavioural changes occur and the duration of the disturbance is usually at least several days. Sometimes the mood state can persist for weeks or even months if not treated. Sometimes periods of depression alternate with periods of mania. For the diagnosis to be made there has to have been at least one episode of mania or hypomania (a mild form of mania).

manic and hypomanic phase of this condition include:

  • a decreased need for sleep, irritability, increased activity, talkativeness, and an inflated sense of self-importance
  • a tendency to be easily distracted
  • an increase in goal-directed activity at home, work or school
  • excessive involvement in high risk/consequence activities, such as spending sprees, unwise business ventures, and irresponsible sexual behaviour. A hypomanic or manic episode may last from a few days to several months.

depressive phase of this disorder is characterised by:

  • low self-esteem and feelings of worthlessness
  • sadness and tearfulness nearly every day
  • suicidal thinking or frequent thoughts of death
  • decreased interest or pleasure in routine activities
  • weight loss or gain
  • Insomnia
  • hypersomnia, which is excessive sleep
  • difficulty concentrating
  • loss of energy or fatigue

Usually this disorder first appears when the person is between the ages of 15 and 35. Adolescents who have had a major depressive episode are at greater risk for developing bipolar disorder later in life, especially if there is a family history. 

While the exact cause of Bipolar affective disorder is unknown, genetics does seem to play a role. Studies have found that if one parent has a bipolar disorder, there is a 25% chance that the child will have a mood disorder. If both parents have bipolar disorder, there is a 50% to 75% chance that their child will develop a mood disorder. Fifty percent of all individuals with bipolar disorder have at least one parent with a mood disorder.

Diagnosis depends on what symptoms the patient is showing. A doctor will conduct a thorough psychological and social history, as well as a physical examination. If symptoms are extreme enough to cause problems in social settings or at work, or require hospitalisation, a bipolar I (bipolar-manic) diagnosis is made. The diagnosis can be difficult to make as impulsive behaviour can resemble other conditions such as personality disorders, ADHD and even normal adolescent behaviour. Subsequently the diagnosis is often delayed. People with this disorder often have problems in their relationships due to the constant mood swings and associated behaviour. Suicide is a risk for people with bipolar disorders.

 
Treatments include psychotherapy and medication. Medications that have been shown to work include: mood stabilisers, such as Sodium valproate, carbamazepine, and lithium. Lithium a discovery of Australian Psychiatrist Dr John  Cade, has been shown to be most effective but is not always tolerated or appropriate. Newer treatment has also included novel anti-psychotic medications. The prescribtion of mood stabilizers is best done by a psychiatrist as they need regular monitoring and have substantial side effects that need to be discussed with patients. Treatment for bipolar disorder tends to be ongoing and therefore medication is monitored. Blood levels are checked frequently to be sure that the medication level is therapeutic.
 
Psychotherapy is usually continued on a regular basis to monitor medication compliance and to be sure symptoms remain well controlled.