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BIPOLAR DISORDER OUTLINE

Cause of bipolar disorder is not known but genetic and environmental conditions may give rise to the disorder and its course. Environmental factors may include substance abuse, medical conditions (e.g. thyroid fluctuation), stressful lie events, and life styles that are consistent with general sleep-wake cycles. PET imaging helps identify differences in brain activities of the people with the disorder. This and other biological researches have rendered better understanding of the causes of the disorder such as dysregulation (not like an epileptic seizure) of the brain cells responsible for regulation of emotions, circadian rhythms and behaviors resulting in the symptoms of the disorder (Goodwin & Jamison, 2007). Bipolar disorder now ranks one of the top ten disabling disorders in the world among working adults with significant socio economic impact (WHO, 2002), (Young, Rigney, Shaw, Emmas, & Thompson, 2011). Bipolar experience of the illness can vary among patients substantially. Such as, some patients with depression followed by hypomania while others, mania followed by depression. Still others with alternating episodes with no intervals of mood stability (euthymia). Choice of treatments therefore is based on individualistic patterns of the disorder (Suppes & Dennehy, 2012). Guidelines of the World Federation of Societies of Biological Psychiatry (WFSBP) for the biological treatment of bipolar disorders mainly deal with the acute treatment of mania and bipolar depression. It is vital that acute and long-term treatment should be simultaneous for treatment planning and evaluation. For simplicity, both are dealt with separately. It is important to bring the acute manifestations under control as quick as possible but it is more important to have maintenance treatment which should prevent new episodes and complications and disabling conditions (Grunz, et al., 2013). See figure below: Grunz et al (2013)’s overall recommendations for long term treatment have assigned Rating Grade (RG) 1 to drugs Aripiprazole, Lamotrigine, Lithium, and Quetiapine which are listed alphabetically. Aripiprazole has been graded A for Prevention of Treatment Emergent Episodes (TEE) in enriched samples (PES) for “mania” and “any episode”. Lamotrigine, has been rated A in PES for “depression” and “any episode”. Lithium, A in PNES (Prevention of TEE in non-enriched samples) for “mania” and “any episode” and B in PES for “any episode”, “mania” and “depression”. Quetiapine, graded A in PES for “mania”, “depression” and “any episode”. The authors’ overall rating goes in favor of Lithium as still the best as it has two grading of A and B for episodes mentioned against each (Grunz, et al., 2013, p. 170). These drugs’ treatments are discussed in detail below. ARIPIPRAZOLE: PES: Monothreapy and combination with Lithium have proved to be efficacious in the prevention of new manic and mixed episodes in acute mania. PNES: As there is no long-term impact study in non-enriched samples, it has been graded F in respect of CE (Category of evidence). Further evidence (FE) of the efficacy of Aripiprazole has been proved in the metaanalysis by Vieta et al (2011) in the prevention of new manic episodes. Safety and tolerability (ST): Most common adverse event (AE) prompting treatment ...Show more

Summary

Bipolar Disorder Outline Introduction Bipolar disorder was distinguished from schizophrenia for the first time in early 1900s and American Psychiatric Association (APA) presented an early conceptualization of the disorder in 1952. Bipolar disorder is characterized by two extreme mood swings of mania and depression and also can be noticed in sleep patterns, energy levels, activity, attention and impulsivity…
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