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South African Family Practice

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Bipolar disorder: an overview

E Bronkhorst, J Motubatse

Abstract


Bipolar disorder (BD) is a chronic disorder characterised by abnormal mood changes and fluctuation in energy levels. The disease is characterised by a depressive episode, which can last up to a few months, and include low energy levels,  hypersomnia, cognitive impairments, decreased sexual desire, carbohydrate craving, and weight gain. Conversely, bipolar disorder also has a stage of exhilaration and excitement, which can be classified as a manic episode. The typical presentation of these episodes of mania includes high energy hallucinations and delusions, sleep deprivation, fast speech and a constant need to be active. Risk  factors that contribute to development of BD include the use of cannabis, influenza during the third trimester of pregnancy, as well as smoking during pregnancy, the use of cocaine, opioids, tranquilisers, stimulants and sedatives during pregnancy, and regular substance use during a period of a year. Parental loss before the age of five, war trauma and stress, as well as traumatic head injury may influence the condition.
Clinical criteria are the mainstay of diagnosis of BD. Differentiating features, which were found to be related to BD, include early age of onset, family history, atypical features and mixed symptoms. Screening tools like the Mood Disorder  Questionnaire (MDQ) and Hypomania Checklist (HCL-32) have shown the ability to differentiate BD from major depressive disorder (MDD). Treatment differs between the different phases of BD, but lithium can be considered as initial monotherapy, since it is effective against manic, depressive and mixed relapses, and has shown better evidence for prevention of new episodes. It is also associated with a reduced risk of suicide and self-harm in BD patients.

Keywords: bipolar disorder, mania, depression, pharmacological management




AJOL African Journals Online