if i’m on fire they dance around it and cook marshmallows. and if i’m ice they simply skate on...
TRANSCRIPT
If I’m on fire they dance around it
and cook marshmallows.
And if I’m ice
they simply skate on me
in little ballet costumes
Anne Sexton was a poetborn in the US who sufferedfrom manic depression
DepressionDepression
Low mood (for at least 2 weeks) withLow mood (for at least 2 weeks) withat least 4 of:at least 4 of:
disturbed sleepdisturbed sleeppoor concentrationpoor concentrationloss of interest & pleasureloss of interest & pleasure // withdrawalwithdrawalreduced appetite & weight lossreduced appetite & weight lossagitation or retardationagitation or retardationloss of energyloss of energyinnapropriate guiltinnapropriate guiltrecurrent thoughts of deathrecurrent thoughts of death
Bipolar Affective Disorder
Is the term used to distinguish those who have manic episodes from those who have only (unipolar) depressive episodes
The relationships with other psychiatric disorders
Symptoms of mania A change in mood often elated but also irritabiltyA change in mood often elated but also irritabilty
This is usually accompanied by This is usually accompanied by
A decreased need for sleep A decreased need for sleep An increased level of energy and activity An increased level of energy and activity Talking more and quickly – difficult to interuptTalking more and quickly – difficult to interuptDistractibilty Distractibilty Disinhibition - doing and saying what we usually only thinkDisinhibition - doing and saying what we usually only thinkOverconfidence – can be grandiose to the level of delusionsOverconfidence – can be grandiose to the level of delusions
Impairment of function – at work or in the family or socially Impairment of function – at work or in the family or socially Usually because of irritability or disinhibition Usually because of irritability or disinhibition
Hypomania is the same symptoms but to a less severelevel and no major impairment in function.
Flight of ideas
“People are cleaning up the house, working very hard, there’s Flash on the floor. The dog doesn’t like Flash. There’s a flash in my eye as I’m looking at the trees, there’s not much oxygen from the trees. There’s water on the floor, agua. Run the water, don’t block the sink.”
Digression with loss of goals. Talk uses combinations Digression with loss of goals. Talk uses combinations of words, sounds and ideas with humour and flippancy of words, sounds and ideas with humour and flippancy
Psychotic symptoms in mania
Delusions are usually grandiose but often paranoid
Depressive delusions can also be present
particularly in mixed states
A mood clock
Normal
Mania Depression
Mixed
0 20 40 60 80 100
MZ Twins
Both parents
DZ Twins
Sibling
Children
One parent
1/2 sib
Grandparent
Uncle/aunt
Cousin
Spouse
General Pop
Unipolar
Bipolar
% risk of major affective disorder
Age of Onset in bipolar illness
0
5
10
15
20
25
30
-15 20 25 30 35 40 45 50 55 60
All
Females
Males
Age
No.ofPatients
Recovery from a manic episode
Kraepelin: “one could hope with great probability for complete restoration of health”
?Average untreated length of about 1 year?– Pollock 1931
Recent studies: 2-3 months
Recurrence of mania
More common than in depressive disorder
– single manic episodes occurred in 2 out of 393 patients in Angst et al 1973
– half will have a recurrence within 2 years
First episode manics
21 patients
15 female : 6 male
(including 5 females post partum)
Average age : 29 years (range 19-47)
Incidence of 5.5 per 100,000 per annum
Prognosis of first episode mania at two years
10 relapsed (8 manic & 7 depressive episodes)
9 remained well
1 died (murder)
1 not traced
Precipitants of recurrence in bipolar disorder
Seasonal changes
Personal adversity
Childbirth
Drugs
Season
Life events
Childbirth
stop lithium
Prophylactic efficacy of lithium in bipolar disorder
2 year placebo controlled study
205 patients on lithium following a manic episode entered trial on discharge.
Half randomly switched to placebo
Hospitalisation:
placebo lithium
70/104 31/101
67% 31%
Non relapsed completers at 2 years
11 (10%) 66 (66%)
Prien et al 1973
Tondo et al 2001
Suicide in bipolar disorderLifetime risk of 15-20%
Most have been recently (or are) depressed
Often late in the course of illness (15 years) particularly females
Inadequate (or non compliant) treatment
Isometsa 1994
Lithium and suicide
Mortality by suicide for bipolars is at least x 2-3 higher than the general population (up to x15?) a rate of 3.2 per 100 patient years
While on lithium ?similar level of suicides to general population 0.37 per 100 patient years
Suicide attempts x10 lower in bipolars when on lithiumcompared to when not on lithium
Schou 1998