Bipolar affective disorder

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Bipolar affective disorder (manic depression/mania)

Cyclical depressive illness characterised by episodes of mood swings/fluctuations and activity. Onset usually early 20’s; Annual incidence of 20/100 000; M/F = 1:1.5; higher risk in higher social classes.

Aetiology:
Has familial component.

Clinical features:
Depressive phase – same as depression
Manic phase – elated mood, irritability, rapid thought and speech, impaired judgement, “flights of ideas”, extreme self-confidence, decrease in social inhibitions, hyper-enthusiasm, hyperactivity, reduced need for sleep, delusions of importance, often indulge in high risk activities (eg questionable business deals, sexual indiscretion, religious initiatives).

Differential diagnosis – substance abuse; mood alterations in endocrine disorders (eg steroid induced); acute schizophrenia; attention deficit hyperactivity

Treatment:
If acute  hospitalisation
Psychotherapy
Pharmacological – main drug is lithium. May be used with a Benzodiazepine for initial control
ECT may be effective

Prognosis – after first manic episode, 90% have recurrences

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