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BIPOLAR DISORDER

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BIPOLAR DISORDER DR. NAZISH NASEEM EPIDIOMOLOGY Life time risk for bipolar disorder is 1%. Life time risk for 1st degree relatives of patients with bipolar disorder ... – PowerPoint PPT presentation

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Title: BIPOLAR DISORDER


1
BIPOLAR DISORDER
  • DR. NAZISH NASEEM

2
BIPOLAR AFFECTIVE DISORDER
  • Mania / Hypomania
  • Bipolar Depression
  • How to identify (DSM IV)
  • Expensive, elated, irritable, elevated mood at
    least for one week.
  • Delusions of grandeur
  • Pressure of speech / flight of ideas
  • Decrease Sleep
  • Excessive involvement in pleasurable activities
  • Distractibility
  • Psychomotor agitation / increase in goal directed
    activity

3
EPIDIOMOLOGY
  • Life time risk for bipolar disorder is 1.
  • Life time risk for 1st degree relatives of
    patients with bipolar disorder is about 10.
  • Prevalence in men and women is the same.
  • Mean age of onset is about 21 years
  • Bipolar disorder is highly co-morbid with other
    disorders, like anxiety disorder and substance
    misuse disorder.

4
CASE HISTORY
  • Saba Agha, 20 years of age, wellkempt with good
    rapport and intense eye contact, irritable,
    quarrelsome and decreased sleep for the last one
    week.
  • After quarreling with her father she left home
    and she was not on any treatment at the time of
    admission.

5
PAST PSYCHIATRIC HISTORY
  • Total duration of illness 5-years.
  • Considered immoral and bad girl by the family
    instead of seeking treatment.
  • Indulged into a relationship and married against
    his fathers will.
  • Could not maintain good marital relationship and
    shifted to the hostel and indulged into
    addiction, ultimately brought to PIMH.

6
FAMILY HISTORY
  • Strict, short tempered and discipliner father.
  • Not allowed to attend school.
  • Frequently beaten up
  • Positive family history of mood disorder.

7
PRECIPITATING FACTORS
  • This episode was precipitated by
  • Quarrel with father
  • Separation from her daughter and husband.
  • Addiction

8
  • PREDISPOSING FACTORS
  • Strong family history of mood disorder in
    grandmother aunt (both paternal).
  • Short tempered strict father.
  • Stressful family environment.

9
  • PERPETUATING FACTORS
  • Poor family support.
  • Conflict of father and husband lead to marital
    disharmony.
  • Poor compliance of treatment.

10
TREATMENT
  • PHARMACOLOGICAL TREATMENT
  • Antipsychotics
  • e.g. Haloperidol, Chlorpromazine Resperidone
  • Sedatives
  • e.g. Lorezepam, diazepam alprezolam
  • Mood stabilizer
  • e.g. Carbamezapine, Sodium Valporate
    Topiromate
  • Depot Injections
  • e.g. Flupenthixol
  • Procyclidine
  • ECT

11
TREATMENT
  • PSYCHOLOGICAL TREATMENT
  • Individual Therapy
  • Cognitive Therapy
  • Family Therapy
  • Family Counseling

12
TREATMENT
  • SOCIAL TREATMENT
  • Interpersonal conflicts
  • Amongst the family should be resolved.
  • Differences between her in laws and father
    should be resolved
  • Her husband and parents should be told about her
    mental illness and guidelines should be given
    regarding her treatment and follow-ups.

13
PROGNOSIS
  • If the marital problems improve then immediate
    prognosis is good.
  • However several predisposing factors noted above
    indicate that she may develop further manic
    disorders particularly at future times of stress.
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