Bipolar affective disorder – synonyms, diagnosis, treatment
Synonyms. Manic-depressive psychosis, cyclothymia
Definition of bipolar affective disorders. Recurrent occurrence of successively replacing each other depressive and (hypo-) manic phases.
Epidemiology:
– Age prevalence – 1-5%, depending on the diagnostic criterion
– The first manifestation in most cases at the age of 25
– The ratio of men: women = 1: 1
Etiopathogenesis of bipolar affective disorders:
– Genetic factors
– Organic dementia and neurobiochemical features – Stress effects
– Impulsiveness
Classification of bipolar affective disorders by ICD-10:
– Hypomania episode (F31.0)
– Manic episode (F31.1, 31.2 depending on the severity and presence of psychotic disorders)
– Depressive episode (F31.3, 31.4, 31.5 depending on the severity)
– Combined episode (F31.6) – Other bipolar affective disorder (F31.8)
– Bipolar I: the alternation of mania and depression
– Bipolar II: the alternation of hypomania and depression
Criteria:
– The alternation of signs of mania, hypomania and depression
– The course of the disease is necessary to study
Differential diagnosis: hyperthyroidism, schizophrenia, schizoaffective / cycloid psychosis, misuse of various substances
Treatment of bipolar affective disorders:
– Basic therapy with the use of mood stabilizers for several years
– lithium preparations (confidence level A)
– carbamazepine, valproates (confidence level B)
– atypical antipsychotics (confidence level B)
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– Environmental and social therapy
– Psycho-education, behavioral therapy
– Work with relatives and relatives of the patient / family therapy
Important: With mania there is a danger of a sudden change of mood under the influence of antidepressants, therefore in such cases the use of mood stabilizers is always required!
Current / Prediction: – Bipolar disorders occur with periodic relapses and begin in most cases from a depressive episode – Early onset of depression, a family history with the presence of mania and psychotic symptoms predetermines bipolar course – A calendar of phases helps to evaluate and analyze the course, an example is shown in the figure.
The long-term prognosis is predominantly unfavorable due to the relatively late diagnosis and treatment, the “unreliability of patients,” as well as due to numerous comorbidities and personality disorders. Patients often lose their working capacity early. 5-10% of patients develop a so-called high cycle, defined as> 4 affective episodes per year.