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Disorder. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG,
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Accessed June 16, 2012.
- Manic-depressive illness (or disorder)
- Manic depression
- Mood disorder
- Mood swings
- Rapid mood cycling
- Cyclical, life-long disorder with recurrent extreme fluctuations
in mood, energy, and behavior.
- Theoretical causes:
- Genetic factors
- Perinatal insult
- Head trauma
- Environmental factors
- Psychosocial or physical stressors
- Nutritional factors
- Medical conditions that can induce mania:
nervous system (CNS) disorders
- Electrolyte or metabolic abnormalities
- Endocrine or hormonal dysregulation
- Drug withdrawal syndromes
- Drugs that can induce mania:
- Dopamine agonists
- Norepinephrine-augmenting agents
- Thyroid preparations
- Various theories:
- Dysregulation between
excitatory and inhibitory neurotransmitter systems
- Excess of catecholamines (primarily norepinephrine and dopamine)
- Deficiency of gamma aminobutyric acid (GABA) or excessive
glutamate activity causing dysregulation of neurotransmitters (e.g.,
increased dopamine and norepinephrine activity)
- Deficiency of acetylcholine causing imbalance in cholinergic-adrenergic
- Lifetime prevalence: 0.4–1.6% for bipolar
I disorder, 0.5% for bipolar II disorder.
- Lifetime prevalence rate of manic episode: 1.6% for
men, 1.7% for women in United States (~4 million people).
- Bipolar I disorder occurs equally in men and women; bipolar
II disorder more common in women.
- 80–90% of patients have biologic relative
with mood disorder.
- First-degree relatives of bipolar patients have 15–35% lifetime
risk of developing any mood disorder and 5–10% lifetime
risk for developing bipolar disorder.
- Manic episode
- Usually begins abruptly;
symptoms increase over several days.
- Severe stages may include bizarre behavior, hallucinations,
and paranoid or grandiose delusions.
- Marked functional impairment or need for hospitalization.
- May be precipitated by stressors, sleep deprivation, antidepressants,
CNS stimulants, or bright light.
- Hypomanic episode
- Absence of marked impairment
in social or occupational functioning, delusions, and hallucinations.
- Patients may be more productive and creative than usual during
episodes, but 5–15% rapidly switch to manic episode.
- Major depressive episode
- Patient in bipolar
depression often has mood lability, hypersomnia, low energy, psychomotor retardation,
cognitive impairments, anhedonia, decreased sexual activity, slowed
speech, carbohydrate craving, and weight gain.
- Delusions, hallucinations, and suicide attempts more common
in bipolar depression than unipolar depression.
- Mixed episode
- Occurs in up to 40% of
all episodes, often difficult to diagnose and treat, and more common
in younger and older patients and women.
Means of Confirmation
- Classification of bipolar disorders:
I: Manic episode with or without major depressive or mixed episode
- Bipolar II: Major depressive episode with hypomanic episodes
- Cyclothymic disorder: Chronic fluctuations between subsyndromal
depressive and hypomanic episodes (2 years for adults and 1 year
for children and adolescents)
- Bipolar disorder not otherwise specified: Mood states do not
meet criteria for any specific bipolar disorder.
- Diagnosis requires occurrence of manic, hypomanic, or mixed
episode (not caused by any other medical condition, substance, or ...