Bipolar I Disorder, Most Recent Episode Manic
The patient's most recent episode is of mania.
The patient has had at least one Major
Depressive, Manic
or Mixed Episode.
Schizoaffective disorder doesn't explain the above episodes
better, and they aren't superimposed on Schizophrenia,
Schizophreniform Disorder,
Delusional Disorder or
Psychotic Disorder Not Otherwise Specified.
Include
any specifiers that apply to this Manic
Episode or to the overall course of the disorder.
Bipolar
I Disorder, Most Recent Episode Hypomanic
The patient's most recent episode is Hypomanic.
The patient has previously had one or more Manic
or Mixed Episodes.
The symptoms cause clinically important distress or impair work,
social or personal functioning.
Schizoaffective disorder doesn't explain the above episodes
better, and they aren't superimposed on Schizophrenia,
Schizophreniform Disorder,
Delusional Disorder or
Psychotic Disorder Not Otherwise Specified.
Include
any specifiers that apply to the overall course of the disorder.
Bipolar
I Disorder, Most Recent Episode Mixed
The patient's most recent episode is of mixed mania and depression.
The patient has had at least one Major
Depressive, Manic
or Mixed Episode.
Schizoaffective disorder
doesn't explain the above episodes better, and they aren't superimposed
on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder
or Psychotic Disorder Not Otherwise Specified.
Include
any specifiers that apply to this Mixed
Episode or to the overall course of the disorder.
Bipolar
I Disorder, Most Recent Episode Depressed
The patient's most recent episode is Major
Depressive.
The patient has had at least one previous Manic
or Mixed Episode.
Schizoaffective disorder
doesn't explain the above episodes better, and they aren't superimposed
on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder
or Psychotic Disorder Not Otherwise Specified.
Include
any specifiers that apply to this Major
Depressive Episode or to the overall course of the disorder.
Bipolar
I Disorder, Most Recent Episode Unspecified
The patient has had at least one previous Manic
or Mixed Episode.
These symptoms cause clinically important distress or impair
work, social or personal functioning.
Schizoaffective disorder
doesn't explain the above episodes better, and they aren't superimposed
on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder
or Psychotic Disorder Not Otherwise Specified.
The symptoms are not directly caused by a general medical condition
or the use substances, including prescription medications.
Include
any specifiers that apply to the overall course of the disorder.
Evaluation:
History:
Interviews with family or friends are essential. Often a family
history of affective disorders and alcoholism is present in
first-degree relatives. If patient is >40 years of age and
has first manic episode, look for medical causes.
Examination: Evaluate for medical cause, such as drug
abuse or intoxication.
Laboratory Tests: Tests are needed before starting lithium
carbonate, carbamazepine, or valproate (see below under specific
medications). They should also be performed to rule out certain
causes of secondary mania, such as megaloblastic anemia, hyperglycemia
and hypoglycemia, hyperthyroidism and hypothyroidism, systemic
lupus erythematosus, syphilis, HIV, and liver disease induced
by alcohol or other substances.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore,
in his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise
diagnosis.
Bipolar
II Disorder
The patient has had at least one Major
Depressive Episode.
The patient has had at least one Hypomanic
Episode.
There have been no Manic
or Mixed Episodes.
Schizoaffective disorder
doesn't explain the above episodes better, and they aren't superimposed
on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder
or Psychotic Disorder Not Otherwise Specified.
These symptoms cause clinically important distress or impair
work, social or personal functioning.
Specify
Current or Most Recent Episode:
Hypomanic.
Depressed.
Include
any specifiers that apply to the most recent episode, if it
is depressive, or to the overall course of the disorder.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore,
in his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise
diagnosis.
Cause:
The
cause of this disorder is still not established. Many bipolars
have a family history of manic depression while it appears 50%
are unable to find this family background.
Treatment:
There is no known cure for the bipolar disorder but
it is treatable with medication and therapy. However manic depression
is a chronic and recurring disorder in spite of medications
used. Many factors can play into this. For example, for
those who have been diagnosed early and treated early on seem
to be more successful regarding relapse. Rapid cyclers and people
with mixed episodes also seem harder to treat.
Other
important treatment involves exercise, a regulated sleep and
meal plan, avoiding stress, caffeine, alcohol and illicit drugs.
Again, more information in the site.
Hospitalization
is usually indicated for full manic syndromes, since the patient's
well-being is at risk because of impaired judgment. This includes
a risk of death from exhaustion. Consider ECT in medication
nonresponders and pregnant women.
Pharmacotherapy [
See Psychopharmacology Section ] :
Treatment for the bipolar disorder involves the use of psychotropic
medications that may include: lithium, antidepressants,
neuroleptics, ECT etc.
Antipsychotics:
Haloperidol.
Benzodiazepines may be a useful adjunct for sedation.
Antimanic
drugs:
Lithium
Carbonate.
Carbamazepine (Tegretol).
Valproic Acid (Depakene, Depakote).
Verapamil (Calan).
