-IBIS-1.5.0-
tx
mental/emotional
Bipolar Disorder
diagnoses
definition and etiology
definition:
A bipolar condition with cyclic states of mania and depression (see these terms for more information). In 85% of cases, depression dominates the personality cycle
etiology:
There are many possible causes, ranging from circumstantial events to neurotransmitter imbalances to toxicity. Manic phase may be associated with adrenal compensation following liver hypoglycemia in which liver glycogen stores are chronically inadequate; while the depressive phase may be associated with the hypoglycemic drop following adrenal exhaustion, relief of stressors or attempts to relax.
signs and symptoms
signs and symptoms:
depressive phase:
Dysphoric mood or loss of interest or pleasure in all or most of usual activities and pastimes. Symptoms include: depression, sadness, hopelessness, irritability.
At least four of the following symptoms have each been present nearly every day for at least 2 weeks.
» Decreased appetite or weight loss or increased appetite or weight gain.
» Insomnia or hypersomnia.
» Psychomotor agitation or retardation.
» Loss of interest or pleasure in usual activities or decrease in libido.
» Loss of energy; fatigue.
» Feelings of worthlessness, self-reproach, or excessive or inappropriate guilt.
» Decreased subjective ability or actual evidence of decreased ability to think or concentrate; slow thinking; indecisiveness.
» Repeated thoughts of death, suicidal thoughts, desire to die, or actual suicide attempt.
physical findings: Excessive painful trigger points and areas of tenderness over the entire body upon palpation.
lab findings:
Psychological analysis is (+) for depression.
May have absence of diurnal variation in cortisol levels
manic phase:
One or more distinct episodes with a predominately elevated, expansive, hyperactive, or irritable mood (may be violent). The elevated mood may be rather persistent or it may alternate and coincide with depression.
Duration of at least one week (or any duration if hospitalization is required) during which, for most of the time, at least three of the following symptoms have been present (four if the patient has only been irritable) and have persisted to a significant degree:
» Increase in activity at home or at work, or physical restlessness; increased libido.
» More talkative than usual or increased pressure or desire to keep talking; heightened interest in new people, activities, and creative pursuits.
» Flight of thoughts, or subjective experience that thoughts are racing.
» Inflated self-esteem (grandiosity, may be delusional).
» Decreased need for sleep; weight loss.
» Distractibility: attention too easily drawn to unimportant or irrelevant external stimuli.
» Excessive involvement in activities that have a marked potential for painful or serious consequences, unrecognized by the patient: driving fast and carelessly; buying sprees; sexual indiscretions, foolish business investments).
lab findings:
(+) Psychological testing for mania.
course and prognosis
tends to be recurring, chronic disorder requiring repeated therapeutic intervention; conventional approaches include antidepressant and neuroleptic medication, lithium treatment, electroconvulsive therapy and perhaps hospital admission and treatment in severe cases or episodes; prophylactic medication appears to reduce the incidence or severity of episodes.
differential diagnosis
grief
worry
unresolved anger
affective disorders
footnotes