BIPOLAR disorder is characterised by a persistently elated or euphoric mental state with other characteristic features such as irritability, grandiosity, an inflated sense of self-esteem, and easy distractibility, which results in significant social and occupational dysfunction to the patient.

It is subdivided into two categories: bipolar I and bipolar II. It is important for the public and health-care workers to know the difference between the two.

Bipolar disorder typically begins in early adolescence or early adulthood; however, the disorder is being increasingly recognised in children. People may inherit a tendency to develop the illness which can then be triggered by environmental factors such as distressing life events.

Brain development, structure and imbalance of chemicals in the brain are also thought to play a role in the development of bipolar disorder.

BIPOLAR I DISORDER

While it is true that many patients with this disorder have episodes of both depression and mania, a patient requires only a single episode of mania to be given a diagnosis of bipolar I disorder.

The manic episode is characterised by irritability, grandiosity, inflated self-esteem, distractibility, increased goal-directed activity, decreased need for sleep, and increased risk-taking behaviour such as sexual promiscuity unprotected or endangering self or others by activities such as repeatedly driving fast without a seat belt.

The manic episode should cause significant impairment in functioning of the individual and may result in periods of hospitalisation. Patients with this disorder also present in period of depression with characteristic symptoms and signs of a major depressive episode which may include sad mood, loss of interest in pleasure in daily activities, easy fatigability, loss of appetite and weight.

BIPOLAR II DISORDER

This disorder is characterised by periods of hypomania, which is a form of subthreshold mania and has many of the same symptoms as a manic episode but without loss of daily functioning or the need for hospitalisation.

It also includes previous or current episodes of major depression. The duration of a hypomanic episode is significantly less than a manic episode.

TREATMENTS AVAILABLE

The priority in treating patients with bipolar disorder is addressing any suicidal or homicidal ideations the patient may be harbouring and in-patient hospitalisation as needed to prevent self-harm.

Hospitalisation may be necessary to conduct proper evaluations and rule out any organic causes of the symptoms, which may mimic bipolar disorder and also to initiate a treatment regimen.

A significant number of patients have comorbid substance abuse as a means to self-medicate and relieve themselves from the symptoms of the disorder and this issue needs to be addressed as it results in a worse prognosis long-term.

MOOD STABILISERS

Mood stabilisers are the mainstay of therapy and include anticonvulsant agents, atypical antipsychotics and lithium carbonate and have shown efficacy in managing the symptoms of the disorder.

ANTIDEPRESSANTS

Antidepressants in combination with mood stabilisers have been used successfully in managing symptoms, especially for bipolar II disorder. however, care must be taken as monotherapy with antidepressants confers a risk of switch to a manic episode in a previously misdiagnosed depressed patient.

PSYCHOTHERAPY

Psychotherapeutic modalities which have shown efficacy include cognitive behavioural therapy, family-focused therapy and interpersonal therapy. Psychoeducation and explaining the symptoms of the disorder to both patient and family members is the backbone of a psychotherapeutic approach to treatment.

Dr Ashish Sarangi MBBS is a resident in psychiatry at the University Hospital of the West Indies. He may be contacted via email at aks_sarangi@hotmail.com