Bipolar spectrum disorder

Specialties > Mental health

Background knowledge 🧠

Definition

Bipolar spectrum disorder (BSD) includes a range of mood disorders, including Bipolar I, Bipolar II, and Cyclothymic Disorder.
Characterized by fluctuations in mood, energy, and activity levels that impact daily functioning.
Involves periods of mania, hypomania, and depression.
Subthreshold states (not meeting full criteria for bipolar disorder) also included in the spectrum.

Epidemiology

Prevalence of bipolar disorder is approximately 1-2% of the population.
No significant gender difference in overall prevalence, but women may experience more depressive episodes.
Onset typically in late adolescence or early adulthood.
Family history is a significant risk factor.

Aetiology and Pathophysiology

Genetic factors: Strong hereditary component with multiple genes involved.
Neurochemical dysregulation: Involvement of neurotransmitters such as dopamine, serotonin, and norepinephrine.
Environmental factors: Stress, trauma, and substance abuse can trigger episodes.
Neuroimaging: Structural and functional brain abnormalities, particularly in the prefrontal cortex and limbic system.

Types

Bipolar I Disorder: At least one manic episode, with or without depressive episodes.
Bipolar II Disorder: At least one hypomanic episode and one major depressive episode.
Cyclothymic Disorder: Chronic fluctuating mood with periods of hypomanic and depressive symptoms not meeting criteria for full episodes.
Bipolar Disorder Not Otherwise Specified (NOS): Symptoms of bipolar disorder that do not fit the above categories.

Clinical Features 🌡️

Symptoms

Mania: Elevated or irritable mood, increased energy, grandiosity, reduced need for sleep.
Hypomania: Similar to mania but less severe and without significant functional impairment.
Depression: Persistent low mood, anhedonia, fatigue, feelings of worthlessness, suicidal ideation.
Mixed episodes: Simultaneous symptoms of mania and depression.
Rapid cycling: Four or more mood episodes in a year.

Signs

Pressured speech, flight of ideas during manic episodes.
Psychomotor agitation or retardation.
Altered sleep patterns, particularly insomnia or hypersomnia.
Changes in appetite, significant weight loss or gain.
Cognitive impairments, particularly in executive function and memory during depressive episodes.

Investigations 🧪

Tests

Clinical assessment: Detailed psychiatric history, including family history and symptomatology.
Mood scales: Use of scales such as the Mood Disorder Questionnaire (MDQ) for screening.
Laboratory tests: To rule out organic causes (e.g., thyroid function tests, electrolyte levels).
Neuroimaging: MRI or CT to rule out structural brain abnormalities if indicated.
Cognitive testing: May be indicated to assess any cognitive impairment.

Management 🥼

Management

Pharmacotherapy: Mood stabilizers (e.g., lithium, valproate), antipsychotics (e.g., quetiapine), antidepressants (used with caution).
Psychotherapy: Cognitive behavioral therapy (CBT), psychoeducation, and family therapy.
Lifestyle modifications: Regular sleep patterns, avoidance of alcohol and recreational drugs.
Crisis management: Hospitalization may be required during severe manic or depressive episodes.
Long-term management: Regular follow-up, adherence to treatment, monitoring for side effects.

Complications

Increased risk of suicide, particularly during depressive episodes.
Substance abuse, commonly associated with mood instability.
Social and occupational dysfunction, leading to significant disability.
Cardiovascular disease: Higher incidence due to lifestyle factors and medication side effects.
Metabolic syndrome: Associated with antipsychotic treatment.

Prognosis

Chronic condition requiring lifelong management.
Variable course: Some patients experience frequent episodes, while others may have long periods of stability.
Adherence to treatment improves prognosis and reduces relapse rates.
Comorbid conditions, such as anxiety and substance abuse, worsen prognosis.
Early intervention and continuous care are key to improving outcomes.

Key Points

Bipolar spectrum disorder encompasses a range of mood disorders from subthreshold states to full-blown bipolar disorder.
Management includes a combination of pharmacotherapy, psychotherapy, and lifestyle changes.
Close monitoring and long-term management are essential to prevent relapse and manage complications.
Early diagnosis and intervention significantly improve patient outcomes.

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