Bipolar disorders are a group of disorders characterised by episodes of mania or hypomania and depression. In between episodes, mild symptoms of mania and/or depression may, or may not, be present. The bipolar disorders include bipolar I, bipolar II, and cyclothymic disorder. Bipolar I disorder is characterised by mania, while bipolar II disorder is characterised by less severe hypomania. Cyclothymic disorder is the mildest of the bipolar disorders.

A major depressive episode is at least two weeks of at least five of the following symptoms. Intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide.

A manic episode is at least one week of extremely high spirits or irritableness most of the time. A manic episode involves changes in normal behaviour. These include exaggerated self-esteem, less sleep, talking a lot and loudly, being easily distracted, doing many activities at once, risky behaviour, uncontrollable racing thoughts, and quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction. A hypomanic episode is similar to a manic episode but less severe and need only last four days. Hypomanic symptoms do not lead to major dysfunction that mania often causes.

What is the evidence for rates of bipolar disorders in people with PTSD?

Moderate quality evidence finds current bipolar disorder in people with PTSD ranges between 4% for bipolar II disorder and 19% for bipolar I disorder. For any lifetime diagnosis, the rate ranges between 20% for bipolar II disorder and 35% for bipolar I disorder.

August 2021

Image: ©Christos Georghiou – stock.adobe.com

The post Bipolar disorder appeared first on NeuRA Library.

The treatment of bipolar disorder is complex due to the presence of varying configurations of symptoms in patients. The primary treatments for bipolar disorder are pharmacological, and often involve second generation antipsychotics. Based on its high affinity for both serotonin and dopamine receptors, clozapine has been proposed as a treatment for the disorder.

What is the evidence for clozapine?

Moderate to low quality evidence suggests improved symptoms and reduced hospitalisation, suicidal ideation, and aggressive behaviour, and also improved social functioning with clozapine in people with treatment-resistant bipolar disorder. There were no differences in efficacy for mania symptoms between clozapine and olanzapine or quetiapine.

November 2021

Image: ©Aaron Couture – stock.adobe.com

The post Clozapine appeared first on NeuRA Library.

A manic episode is a period of at least one week when a person is high spirited or irritable in an extreme way most of the day for most days. A manic episode involves changes in normal behaviour, including showing exaggerated self-esteem or grandiosity, less need for sleep, talking more than usual, talking more loudly and quickly, being easily distracted, doing many activities at once, scheduling more events in a day than can be accomplished, embarking on risky behaviour, uncontrollable racing thoughts, and/or quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction. A hypomanic episode is similar to a manic episode but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes, and the person is still able to function. The frequency and severity of manic or hypomanic symptoms vary from person to person, and may also vary according to whether the onset of bipolar disorder is in childhood, adolescence, or adulthood.

What is the evidence for mania symptoms in bipolar disorder?

Moderate quality evidence finds the most common mania symptoms reported in youths with bipolar disorder are (in decreasing order); increased energy, irritability, mood lability, distractibility, goal-directed activity, euphoric/elated mood, pressured speech, hyperactivity, racing thoughts, poor judgment, grandiosity, inappropriate laughter, decreased need for sleep, and flight of ideas. Moderate to high quality evidence finds irritability, aggression, and low insight are more common in youths than adults with bipolar disorder. Odd appearance, grandiosity, flight of ideas, decreased sleep, and increased sexual interest are more common in adults with bipolar disorder.

Moderate to high quality evidence finds having a positive family history of any mood disorder is associated with greater likelihood of switching to mania in children with major depression. Moderate quality evidence suggests having subthreshold symptoms of mania, emotional dysregulation, or behaviour problems are also associated with greater likelihood of switching to mania in children with major depression.

In adults with bipolar disorder, moderate to low quality evidence shows increased prior depressive episodes was associated with increased risk of antidepressant-induced mania.

September 2021

Image: ©shidlovski – stock.adobe.com

The post Mania appeared first on NeuRA Library.