Bipolar affective disorder
From Ganfyd
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Contents |
Introduction
A major affective disorder, that is, a disorder of mood, characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Manic Episode.
Types
- Bipolar I – mania, hospitalised
- Bipolar II – hypomania, sometimes secondary to anti-depressants, not hospitalised
Aetiology
Genetic factors
Environmental influences
ICD-10 Classification
Management
Episode of mania or hypomania
Mania is likely to need admission. Effective anti-manic agents include lithium, valproate, antipsychotics. Benzodiazepines provide sedation.
Episode of bipolar depression
- Optimise mood stabilisers
- Addition of antidepressant with mood stabiliser cover
Relapse prevention
Pharmacological options
Multiple agents with demonstrated efficacy in reducing relapse rates. Some seem more effective in preventing mania rather than depression or vice versa. Combination therapy often necessary.
Psychological interventions
Range of psychological therapies can be effective in reducing relapse including psychoeducation and cognitive therapy. These are often of limited availability in the real world. Elements of these can be incorporated into 'routine' care. Clinical Evidence rates 'cognitive therapy' and 'Education to recognise symptoms of relapse' as likely to be beneficial in preventing relapse.
External links
- SIGN. Bipolar affective disorder
- Clinical Evidence. Bipolar Disorder
