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Summary Textbook of psychiatry - H6 Bipolar disorders
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Textbook of psychiatryH6 Bipolar disorders
Introduction
Bipolar disorders are severe recurrent disorders characterized by alternating depressive,
manic or hypomanic (euphoric or irritable mood) symptoms with relatively symptom-free
intervals in between, lasting for shorter periods (days-weeks) or longer ones (months or
years). It is also referred to as ‘manic depressive’ illness.
Bipolar disorders are classified into various subtypes:
Bipolar I disorder involves depressive and manic episodes.
Bipolar II disorder: the depressive episodes are accompanied solely by hypomanic
episodes. It often goes unnoticed, giving the impression of a recurrent depressive
disorder.
Cyclothymic disorder: less severe variant in which depressive and manic symptoms
alternate frequently over a lengthy period but full depressive and full
manic/hypomanic episodes never occur.
Substance/medication-induced bipolar and related disorder
Bipolar and related disorder due to another medical condition
Syndromes:
Key feature of bipolar disorders occurrence of manic/hypomanic episodes.
In a manic/hypomanic episode, there is a euphoric and/or irritable mood, but the most
typical feature is increased activity: the patient is excessively energetic and needs less sleep.
, Mania can be accompanied by psychotic features such as grandiose delusions (e.g. being a
god of having a divine task) and severely impact judgement. Manic patients are often
unaware of their illness and not open to reason. They may harm themselves and people
close to them.
Hypomania does not cause major difficulties and patients sometimes experience them as
positive because of increases activity and creativity (‘really living again at last’).
Manic/hypomanic and depressive disorders can sometimes alternate rapidly (rapid cycling =
at least 4 episodes in a year). This is generally more difficult to treat.
Depressive episode vs depressive disorder:
Distinction between the 2 lies in the previous occurrence of manic/hypomanic episodes.
Depressive episodes in bipolar disorder occur in combination with manic/hypomanic
episodes. Depressive episodes in a depressive disorder occur unipolar.
Alternation of episodes:
Patients with bipolar disorder are more likely to suffer from their depressive than their
manic/hypomanic episodes, and for a longer period. Manic and depressive symptoms are
sometimes found in combination or alternate rapidly (‘manic/depressive episode with mixed
features’).
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