1、Bipolar Disorder: Journey Through Mania and Depression H.E. Logue, M.D. Bias Disclaimer There is no pharmaceutical support for this program. I am active in the research field and involved in clinical trials for most of the major pharmaceutical companies. Goals and Objectives Promote better understan
2、ding of the following aspects of Bipolar Disorder: Prevalence Recognition and Diagnosis Understanding Risk Factors Genetic Predisposition Treatment Considerations Co-morbid Conditions Referral Consideration Richard Dreyfuss Kitty Dukakis Liza Minnelli Carman Miranda Marilyn Monroe J.P. Morgan Ralph
3、Nader Sir Isaac Newton Florence Nightingale Ozzy Osbourne Dolly Parton Boris Pasternak George Patton Jane Pauley Pablo Picasso Cole Porter Abraham Lincoln Joshua Logan Jack London Greg Louganis Martin Luther Imelda Marcos Ann Margaret Herman Melville Burgess Meredith Kurt Vonnegut Vivian Vance Victo
4、r Hugo Edgar Allen Poe Leo Tolstoy Michelangelo Ezra Pound Charlie Pride Sergey Rachmaninoff Patty Duke Thomas Eagleton Thomas Edison T.S. Eliot Ralph Waldo Emerson William Faulkner Eddie Fisher F. Scott Fitzgerald Betty Ford Harrison Ford Stephen Foster Sigmund Freud King George III Tipper Gore Rob
5、ert E. Lee Vivian Leigh John Lennon Alexander Hamilton Joan Rivers Norman Rockwell Charles Schultz King Saul William Tecumseh Sherman Neil Simon Rod Steiger William Styron Alfred, Lord Tennyson King Herod Nathaniel Hawthorne Ernest Hemingway Audrey Hepburn Howard Hughes Thomas Jefferson Joan of Arc
6、Lyndon Baines Johnson Danny Kaye Ted Turner Mozart Larry King Jessica Lange Mark Twain Mike Tyson Jean Claude Van Damme Queen Victoria Mike Wallace George Washington Robin Williams Tennessee Williams Thomas Wolfe Virginia Woolf Lord Tennyson Vincent van Gogh Peter Tchaikovsky F. Scott Fitzgerald Cha
7、rles Dickens Robert Louis Stevenson Walt Whitman Sylvia Plath Marlon Brando Art Buckwald John Bunyan Rodney Dangerfield Charles Darwin King David John Denver Princess Diana of Wales Charles Dickens Emily Dickenson Theodore Dostoevski Jack Dreyfus Drew Carey Dick Cavett Ray Charles Frederick Chopin W
8、inston Churchill Dick Clark Rosemary Clooney Kurt Cobain Natalie Cole Samuel Coleridge Sheryl Crow Irving Berlin Steven Foster Lord Byron (George Gordon) Noel Coward Alexander the Great Edwin “Buzz” Aldrin Hans Christian Anderson Roseanne Barr Ludwig Von Beethoven William Blake Napoleon Bonaparte Pr
9、evalence Bipolar Disorder affects approximately 5.7 million adult Americans The median age of onset for Bipolar Disorder is 25 years. An equal number of men and women develop Bipolar Disorder and it is found in all ages, races, ethnic groups and social classes. Bipolar Disorder is the sixth leading
10、cause of disability in the world. Bipolar Disorder results in 9.2 years reduction in expected life span, and as many as one in five patients with bipolar disorder completes suicide. Bipolar Disorder Subtypes Classic Bipolar Disorder Bipolar I Bipolar II Subtypes Cyclothymia Major Depression Unipolar
11、/Recurrent Dysthymic Disorder Bipolar NOS (Not Otherwise Specified) Other Considerations Rapid Cycling (part of Bipolar I) Post-partum Onset Seasonal Pattern Mood Disorders Five or more of the following: Depressed mood Diminished interest or pleasure in activities Significant weight loss/gain or dec
12、rease/increase in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate, or indecisiveness Recurrent thoughts of death, recurrent suicidal ideation witho
13、ut a specific plan, or a suicide attempt or a specific plan for committing suicide. DSM-IV Criteria - Depression Diagnostic Dilemmas Secondary Depression Depression with Other psychiatric illnesses Schizophrenia Anxiety Panic disorder Obsessive-compulsive disorder Personality Disorders Borderline Co
14、mpulsive Post-traumatic stress disorder Post-partum depression Grief/depression Practically any psychiatric disorder Depression with Organic/Medical Illnesses Hypothyroidism B-12 deficiency Folate deficiency Tuberculosis Myasthenia gravis Diabetes mellitus Hepatitis C Cushings disease Mononucleosis
15、Parkinsons disease CHRONIC FATIGUE SYNDROME DSM-IV Criteria - Mania Three or more of the following: Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractibility Inc
16、rease in goal-directed activity or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences Mood Symptoms Euphoria/Mania Depression (in mixed state) Anxiety Anger Hostility Irritability Behavioral Symptoms Energized Activity Diminished
17、 Need to/for Sleep Impulsivity Anger with Violence Elevated Libido Diminished Inhibitions Reckless Behavior Cognitive Symptoms Racing Rapid Thoughts Diminished Insight/Invincibility Sensory Hyperacuity Hallucinations Delusions Perceptual Distortions Distractible Disorganized Thoughts S-H-O-T S: Symp
18、tomatology Do the symptoms appear to be manic or depressed or repeated episodes of depression or mania or continuing mood swings? H: History What is the history of the person? The history of the family? Is there a family history of mood swings, mood disorders, substance abuse in persons with mood di
19、sorders or Bipolar diagnosis? O: Ongoing illness What is the progression of the illness? What is the course of the disease? Does it continue to go on in a progression appearing as a Bipolar disease course? T: Treatment response If one looks at the response of the treatment one should get a good dedu
20、ction as to the nature of the illness. Understanding Risk Factors Stress (major or prolonged) Sleep Deprivation/Disruption Alcohol (major problem) “Recreational” Drug Use Discontinuation of Medications Loss or Perceived Loss (job, family, friends, finances, health, etc.) Interpersonal Conflict Trave
21、l Across Time Zones Mood-Altering Medications (benzodiazepines, antidepressants, antipsychotics) Death of Loved One or Friend Inadequate Coping Skills Early Dementia or Minimal Brain Damage Treatment Depression: Pre-Modern Era Tincture of Time Prescribed trip to Europe Activity Physical Social Menta
22、l Somatic Insulin shock Electric shock Spiritual Depression: Modern Era Education and Psychotherapy Pharmacotherapy 1950s Tricyclics 1960s Tetracyclics, etc. 1990s SSRIs (Prozac, Paxil, Zoloft) SNRI (Wellbutrin) SSNRIs (Effexor, Remeron, Cymbalta) Spiritual Depression vs. Bipolar Depression Treatmen
23、t Statistics Patients with Bipolar Disorder face up to ten years of coping with symptoms before receiving an accurate diagnosis. Nearly 9 out of 10 patients with bipolar disorder are satisfied with their current medication(s), although side effects remain a problem. Participation in a Depression and
24、 Bipolar Support Alliance patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. Consumers who report high levels of satisfaction with their treatment and treatment provider have a much more positive outlook about their illness and their
25、ability to cope with it. Bipolar Disorder Type II (Depressed Type) Incorporate all of the previous slide Recent studies suggest antidepressants cause a sooner relapse or conversion to mania Treating the Bipolar component is equivalent to casting both broken legs. Mood stabilizers Lithium only drug p
26、roven to reduce suicide rate Antidepressants 1950s Richard Dreyfuss 1990s Depakote, Tegratol, Trileptal, Lamictal Atypicals? Bipolar Disorder Type I (Manic and Depressive) Mania Antipsychotics 1953 Thorazine/chlorpromazine Worlds first psychotropic medication Could treat psychosis and mania Other co
27、nventional antipsychotics followed Risk and Benefits Atypical Antipsychotics Zyprexa, Seroquel, Abilify, Risperdal, Geodon Risk and Benefits Anticonvulsants Depakote, Tegratol, Trileptal, Lamictal Risk and Benefits Electroconvulsive Therapy Genetics Like the illness, a complicated topic Confounding
28、issues: Hypersexuality Family disintegration Separation of siblings Twins Genetic Models Mendelian vs. Polygenic Models 1 affected parents = 1 in 4 affected offspring 2 affected parents = 2 in 3 affected offspring 1 dizygotic/fraternal twin = 1 in 6 affected twin 1 monozygotoc/identical twin = 2 in 3 affected twin Epistatic Model Number 22 is prominently mentioned (same gene as schizophrenia Gene 21q is also involved Genes 18p and 18q also are involved
