Friday, December 26, 2014

UNDERSTANDING A DIAGNOSIS OF BIPOLAR DISORDER?

 A common diagnosis in psychiatry is bipolar  disorder. Though Dr. Hagop S. Akiskal may  have propounded a 7 type classification of  bipolar disorder which is very famous but it is an  equally well-known fact that the most common  classification practiced is of Bipolar 1 and  Bipolar 2.

 Now what it is being Bipolar?

 Bipolarity in its common meaning means  exhibiting 2 different poles in same person and  that is exactly what happens. A person  diagnosed as bipolar disorder certainly falls into  depression for months and then lifts into mania  or hypomania. Many people exhibit swings of  mood from being into sad state to joyous. Are  they always bipolar?
 A simple answer is no. There is a specific set of  symptoms which should be exhibited for certain  duration of time to be called bipolar.
 Now let us discuss both commonly used of  bipolar disorder types.

 BIPOLAR 1

 Bipolar 1 is diagnosed when a patient shows a  clear picture of separate episodes of mania and  depression separated invariably by a period of  normalcy which should be ideally for 2 months.
 A typical maniac episode characterizes by- 
 1. A persistent irritable or euphoric mood.            Plus 3 for euphoric and 4 for irritable of    following  symptoms 
 2. Decreased need for sleep
 3. Grandiosity- characterized by delusion of      power, wealth or position. 
 4. Increased activity 
 5. Hyper sexuality 
 6. Pressure of speech-Speech which is fast    than normal to the extent of being  incomprehensible. 
 7. Decreased appetite 
 8. Planning 
 9.Overfamiliarity 
 10. Recklessness, overconfidence and  dis    tractability.
 Symptoms should be present for more than 7  days.
 A typical depressive episode characterizes by-
 Major symptoms
 1.       Persistent sad mood
 2.       Decrease in energy levels
 3.       Loss of interest in once pleasurable  activities.
 Minor Symptoms
 1.       Decreased or increased sleep
 2.       Decreased or increased appetite
 3.       Decreased level of concentration
 4.       Decreased level of confidence
 5.       Loss of libido
 6.       Guilt
 7.       Weight loss
 8.       Social withdrawal
 9.       Suicidal tendencies
 A milder form is diagnosed when 2 major plus 2  minor symptoms are present and a severe form  when at-least 3 major plus 4 minor symptoms  are present.
 Duration of at-least 15 days is required except in  case of rapid very severe type with major socio-  occupational disruption.
 Both mania and depression can have secondary  psychotic symptoms.

 BIPOLAR 2

 Bipolar 2 is diagnosed when a patient shows a  clear picture of separate episodes of hypomania  and depression separated invariably by a period  of normalcy which should be ideally for 2  months.
 A typical hypo-maniac episode characterizes by-
 1.       A persistent irritable or euphoric mood.
                               Plus
 3 for euphoric and 4 for irritable of following  symptoms
 2.       Decreased need for sleep
 3.       Grandiosity- Grandiosity is not at  delusional level.
 4.       Increased activity
 5.       Hyper sexuality
 6.       Push of speech instead of pressure is  present
 7.       Decreased appetite
 8.       Planning
 9.       Overfamiliarity
 10.   Recklessness, overconfidence and  distractibility.
 Symptoms should be present for not more than  4 days or not so severe to be disruptive socio-  occupationally non psychotic or require  hospitalization.
 A typical depressive episode characterizes by-
 Major symptoms
 1.       Persistent sad mood
 2.       Decrease in energy levels
 3.       Loss of interest in once pleasurable  activities.
 Minor Symptoms
 1.       Decreased or increased sleep
 2.       Decreased or increased appetite
 3.       Decreased level of concentration
 4.       Decreased level of confidence
 5.       Loss of libido
 6.       Guilt
 7.       Weight loss
 8.       Social withdrawal
 9.       Suicidal tendencies
 A milder form is diagnosed when 2 major plus 2  minor symptoms are present and a severe form  when at-least 3 major plus 4 minor symptoms  are present.
  Duration of at-least 15 days is required except  in case of rapid very severe type with major  socio-occupational disruption.
 Depression can have secondary psychotic  symptoms.
 Apart from the above mentioned differences  there are several other differences
 1.       Bipolar 1 usually starts with maniac  episode and bipolar 2 with depressive.
 2.       There are more chances of suicide in  bipolar 2 than 1.
 3.       Lamotrigine is more effective in bipolar 2.
 Apart from these types there is a mixed type  too, rapid cyclers and ultra-rapid cyclers but  these are present in very less amount of cases.

 With best wishes for healthy and long life
 Dr Hitesh Sharma 
 MBBS, MD (Psychiatry)