Bipolar Disorder

Abstract:

Bipolar Disorder has long been considered to be a condition best managed by pychopharmacologically and psychotherapy specific to bipolar disorder has only recently been a subject of interest.

In our overview in this chapter on bipolar disorder we examine nosology of the DSM-IV bipolar disorders, review diagnostic criteria for manic and hypomanic episodes, discuss epidemiology and psychiatric co-morbidities and describe the clinical course of bipolar disorder.

Prominent agents in the pharmacologic management of bipolar disorder are discussed as the foundational maintenance factors in bipolar disorder with a review of the putative pros and cons of management with lithium, anti-epileptic drugs, atypical antipsychotics, and standard antidepressants.

Three manual based psychotherapies have been studied under controlled conditions in bipolar disorder; family focused therapy, cognitive therapy, and interpersonal social rhythms therapy. We summarize the principles of these interventions as well as outcome data of clinical studies for these interventions in the management of people with bipolar disorder.

In basic competencies, some of the more common and difficult issues with differential diagnosis are considered, including differentiating unipolar major depressive disorder, borderline personality disorder, and schizophrenia from bipolar disorder. Topics in psychoeducation are presented. The section on expert compentencies expands on these principles, and discusses the use of diagnostic instruments such as the Structured Clinical Interview for Diagnosis (SCID) of DSM-IV TR Mental Disorders, screening instruments such as the Mood Disorders Questionaire (MDQ), and rating instruments such as the Young Mania Rating Scale (YMRS) Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Depression Rating scale (MADRS).