Bipolar Disorder

Eduard Vieta, M.D., Ph.D., Estela Salagre, M.D., Iria Grande

, M.D., Ph.D., André F. Carvalho, M.D., Ph.D.,
Brisa S. Fernandes, M.D., Ph.D., Michael Berk, M.D., Ph.D.,
Boris Birmaher, M.D., Mauricio Tohen, M.D., Dr.P.H.,
Trisha Suppes, M.D., Ph.D.
Bipolar Disorder

• Bipolar disorder (BPAD) is a serious mental disorder characterized

by episodes of depression, hypomania/mania and mixed episodes,
with interepisodic recovery.

• Bipolar disorder is a recurrent disorder that affects more than 1% of

the world population and usually has its onset during youth.

• Its chronic course is associated with high rates of

morbidity and mortality, making bipolar disorder one of the main ca
uses of disability among young and working-age people.
Known Risk Factors and Early sign
 Early intervention  chronic
Risk Factors

• Environmental Risk Factors

• Biological Risk Factors

Enviromental Risk Factors
1 Multifactorial disease

2 Life event

3 Lifetime sexual abuse

Antidepressant use  hypomanic symptoms

4
Biological Risk Factors
1 Family history  increased risk for any bipolar disorder

2 Lithium no responsiveness in parent

3 Children with the highest academic attainment

Prodormal
Symptomps
 Clinical
Manifestation
DSM-5 defines major depressive disorder as having either depressed
mood or markedly diminished pleasure in most activities for most da
ys during at least 2 weeks. In addition, at least 4 of the following mu
st be present during the same period:
• Appetite disturbance
• Sleep disturbance
• Motor retardation or agitation
• Lack of energy
The DSM-5 defines mania as the presence of persistently elevated, e
xpansive, or irritable mood with increased activity for more than 1 w
eek. In addition, at least 3 of the following features must be present,
with impaired functioning (4 features are required if mood is only irr
itable) :
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Pressured speech
• Racing thoughts
Hypomania is a less severe condition, in which the abnormally eleva

ted mood is of shorter duration (4–7 days) and meets the other criteri

a for mania but without significant functional impairment.

Bipolar Disorder Onset Through Screening Tools

• Mood disorder questionnaire

• The General Behaviour Inventory

• The Child Behaviour Checklist-Pediatric Bipolar Disorder

Table 1. Child Behavior Checklist-Mania Scale items and corresponding core and extended DSM-IV criteri
a for Mania.

Papachristou E, Ormel J, Oldehinkel AJ, Kyriakopoulos M, Reinares M, et al. (2013) Child Behavior Checklist—Mania Scale (CBCL-MS): Develop
ment and Evaluation of a Population-Based Screening Scale for Bipolar Disorder. PLOS ONE 8(8): e69459. https://doi.org/10.1371/journal.pone.00
69459
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069459
Early Treatment Strategies
• Lithium karbonat (2 years)  early course of diagnosis

• Mood stab and antipsychotic  short and long term advers

e effects , so their use as first-line treatment in at-risk
youths might not be recommendable

• Anti-inflammatory strategies (Aspirin)  reduce risk depres

sion

• Valproate sodium  reproductive endocrine abnormalities a

nd should be used with caution in women childbearing age

• lithium monotherapy for a period of up to 2 years was assoc

-iated with a significantly lower rate of relapse