Bipolar Disorder: Diagnosis & Treatment
Bipolar disorder is characterized by fluctuating mood states, including mania/hypomania and major depressive episodes. Effective management requires long-term mood stabilization to prevent cycling.
Key Classifications
| Type | Clinical Criteria |
|---|---|
| Type I | At least one manic episode; depressive episodes are common but not required. |
| Type II | Hypomanic episodes and at least one major depressive episode; no full manic episode. |
| Cyclothymia | Chronic, fluctuating hypomanic and depressive symptoms for $\ge 2$ years. |
Pharmacological Management
- Lithium: Gold standard for mood stabilization and suicide prevention; requires monitoring of plasma levels, thyroid function, and renal function.
- Anticonvulsants: Valproate (effective for mania), Lamotrigine (highly effective for bipolar depression).
- Antipsychotics: Atypicals (e.g., Quetiapine, Aripiprazole, Olanzapine) are effective in both acute manic/depressive phases and maintenance.
High-Yield Clinical Notes:
- Antidepressant Risk: Use of antidepressants (SSRIs/SNRIs) without a mood stabilizer in bipolar patients can precipitate a manic switch or increase cycling frequency.
- Lithium Toxicity: Triggered by dehydration, NSAIDs, or ACE inhibitors. Symptoms include coarse tremor, ataxia, confusion, and potential seizures.
- Maintenance: Adherence is the primary challenge; psychoeducation and family therapy are essential components of treatment.