Patients with bipolar disorder type II are suffering from a severe bout of depression or more with the heart and at least one from under the mania.
Distinguish bipolar disorder is important because the treatment differs from the standard treatment in the case of disorder and unipolar and the neglect of the situation leads to high morbidity and mortality.
In most cases are not detected bipolar disorder, patients are re-examining the clinic filed a complaint include depression, especially in primary care clinics, but take the story of clinical Court may reveal evidence of previous episodes of mania or mania under which directs the diagnosis.
Epidemiology and pathogenesis:
Estimated prevalence of bipolar disorder (1%) (2)% and, more recently, the spectrum of bipolar disorder has been expanded to include bipolar disorder under the threshold with a high prevalence rate of 6.2 to 5.6% (4-7).
World Health Organization considered bipolar disorder sixth reason behind the underlying deficits at the ages between 15 and 44 years old.
The true prevalence of bipolar disorder is a well-defined and often get an error in diagnosis when the patient suffers from depression and are not survey for symptoms that indicate previous episodes of mania or under the mania.
In studies on outpatients who were treated for depression in the family medicine clinic, the questionnaire examined bipolar disorder (the mood disorder questionnaire MDQ) was positive at 21.3 percent and two-thirds of this figure has not been diagnosed bipolar disorder to have.
Sensitivity and specificity of this survey was 60% and 90% respectively when it was compared with the results of this questionnaire with the standard manual DSM-IV mental disorders and mental health (DSM-IV) of the American Society of Psychiatry has also been identified in the interviews, clinical closed.
Bipolar disorder affects men and women the same rate, but the turmoil of the second pattern is common in all larger in women and the age of onset is generally between 15 and 30.
Newly diagnosed mania is uncommon in children and adults over the age of 65.
Genetics:
Studies conducted on families and twins and adoption cases showed the importance of genetics in the pathogenesis of bipolar disorder.
Approximate relative risk in relatives of people with a bipolar disorder is equal to 40-70% for monozygotic twins and 5-10% for first-degree relatives compared with 0.5 -1.5% of the people far away.
In the study of large Hacdah for 2 million households in Sweden, the risk of bipolar disorder was increased in case of injury a sick parents or siblings
And the risk was increasing, but the extent is less than the previous one when the first-degree relatives suffering from schizophrenia (schizophrenia) and that the risk of schizophrenia was also increased in case of injury a relative bipolar disorder, which indicates the presence of genes affecting the same.
Search for the gene affecting the title of legal studies in spite of the inability to identify a single gene.
Expected to be complex interactions between genes and environmental factors are responsible for the occurrence of this disease.
Most genetic studies have focused on the transportation system affected the nervous pharmacological treatments applied in the clinical management of this disorder but did not get any significant results.
Relevant studies suggested a role for the enzyme tryptophan hydroxylase 2 (TPH2) (19), which play a significant role in determining the rate of synthesis of serotonin.
Extensive genetic studies have found genetic patterns related to multiple bipolar disorder and also showed that the site is the most CACNA1C genetic susceptibility and line to link with this disorder, it symbolizes the gene under the units in the enclave, a calcium channel within the portal.
Was to prove a role for calcium channels in bipolar disorder by examining the lithium salts were used the most common medication for this disorder and who could organize the work under the units of these channels in brain tissue of mice.
Demonstrations and clinical diagnostic criteria:
The diagnosis of mental disorders on clinical events and the history of the onset of symptoms where the important role of the diagnostic criteria for distinguishing between similar disorders, Kaltvriv between bipolar disorder and depression.
Of mania: a phase of clear cases of persistent and severe period of irritability and agitation and high mood lasting for at least a week or any period in the event of acceptance was in the hospital.
During the seizure disorder must manifest at least three of the following symptoms, provided that these symptoms do not return to the use of a particular drug or substance:
1. Vanity or self admiration
2. The lack of need for sleep.
3. Too much talk or chatter.
4. Stray ideas or meaningful.
5. Straying.
6. Increase the activity and vitality.
7. Too much fun and enjoyment of self Ksrv funds reckless and personal pleasures.
These behavioral changes lead to social problems, large and functional.
More frequent symptoms are those that come in the form of episodes of mania included many high-pitched speech, and excessive motor activity and agitation with a lack of desire for sleep and hypersexuality and waste.
Less common manifestations of violence, religion and the withdrawal and cases of deadlock.
You may also get cases of despair and weakness of hope and lack of cooperation by the patient well.
Patients may suffer from depression or excessive irritation or sense of self or feelings change and wandering through the bouts of mania may come in the form of a heart over-happiness or sexual desire.
Seizures manifest in the form of mixed symptoms of depression may develop into severe depression punctuated by episodes of mania or excessive happiness.
Below the mania or hypomanic: refers to the brief periods of manic episodes at least 4 days or sometimes refers to severe symptoms under.
Standards adopted in the diagnosis of mental illness shows that the
1. Impairment of mental functions occur in the event of mania, while absent in the case under the mania.
2. Below the strike is causing a mild obsession with work, or you may improve it, while the obsession it caused a stir in sensory functions and the physical and social problems.
3. Obsessive zeal might lead a person to the hospital while under the obsession with what does not cause entry to the hospital.
Depression: According to the approved standards of mental illness and used in the diagnosis of major depression, it should be available 5 together, at least one of 9 symptoms of low mood or loss of interest. Symptoms must pretend to daily or almost daily for more than, two weeks at least.
Symptoms must cause demonstrations clinical serious sadness or dysfunction, do not belong directly to a substance such as hyperthyroidism taking certain medications or medical condition, as in the lack of thyroid activity, and occurred after more than Chehrian of the beloved exception of the case of death.
Bipolar disorder under divided into two types:
1. Patient bipolar mood disorder with the story of a single episode of mania, at least, with or without prior history of depression to heart.
Despite the fact that depression is essential in the diagnosis of bipolar mood disorder, it pretends to be more common than episodes of mania for most patients.
2. The story of a patient with at least one major depressive episode and the story of a seizure under the obsession.
Ticket (below obsession manifests cases of high mood compared with the other two individuals that do not reach the owner to the hospital).
Although patients with type II patients with bipolar mood strikes appear less obsession with the impact of the disease on their lives and activities similar to patients with Type I have an increased risk of committing suicide.
Bipolar disorder Rapid cycling fast loop
Known as bipolar disorder Rapid cycling loop fast as the occurrence of four or more episodes of mood swings during the period of 12 months.
Sir clinical: The course of bipolar disorder type 1 is characterized by Balinks and improvement, often alternating the bipolar manic depressive disorder depressive, About 90% of the patients with heart obsession and one will get another 5 years, and about 90% of patients with bipolar disorder have at least a visit to the psychiatric hospital and two thirds of the patients had two visits or more during their lives.
The bipolar disorder type 2, he did not study well, did not understand how after walking.
The average life of a person with bipolar disorder are low and clear, with about 25-50% of diagnosed patients attempt suicide, and 15% die suicide. This provides us with suitable high between suicide attempts in patients with bipolar disorder than in patients with the first phase of Axis I (which is often mental disorders and disorders in the learning process)
Include the risk factors for attempted suicide in patients with bipolar: a personal story or family to suicide, as well as the severity and frequency of episodes of depression, abuse of alcohol and other substances, and the degree of pessimism pessimism, and the degree of motivation impulsivity, and start serious the situation during young adulthood early.
Distinguish depression and bipolar mono: Patients with bipolar disorder, especially type 2 and who do not show obvious symptoms of mania are usually diagnosed condition error as unipolar depression.
So is the proof of the diagnosis of bipolar disorder is important to gain access to effective treatment for episodes of acute and provide supportive therapy. Installed as prescribed drugs for mood for most of the patients who suffer from depression and bipolar disorder, in order to avoid changes and mood swings between manic and hypomanic.
The patients with bipolar depression compared with unipolar patients often have a family history of bipolar disorder cases, which are usually an early start. Since these patients (ie, depressed) should ask them, and in particular the existence of any symptoms of psychosis or mania, under, through some of the questions such as:
Do you experience periods of constant sense of vitality is the model?
Do you experience periods of lack of sleep without feeling tired?
Did you feel that your thoughts are racing without being able to stop it?
Do you experience periods of high you want the exercise and enjoyment of sex, or spending money, or risk-taking is not familiar?
The case of mixed: refer this case to demonstrate symptoms of both depression and mania together, this situation may occur in Aztarab bipolar type 1, 2, or in cases of major depression, major depression, although more common with cases of bipolar disorder.
The estimated frequency of depression mixed with these cases, between 20 and 70%.
In cross-sectional study a large cross-sectional study conducted on patients with bipolar found that 12% of the 1380 patients who suffer from symptoms of depression also suffering from mania simultaneously with the situation, and, of course, depending on the criteria DSM-IV of obsession, but noted that some symptoms of mania were present when more than half of the patients, the most common symptoms are: agitation irritability, competing ideas Ooualemtsabakh racing or crowded thoughts, psychomotor agitation psychomotor agitation, or frequent chatter with concurrent symptoms of depression.
The presence of diagnostic features under subsyndromal (do not give conclusive evidence for the diagnosis) is a case of mania associated with bipolar disorder is characterized by severe (early start and a quick loop and is associated with greater likelihood of suicide attempts).
Periodic mood Cyclothymia: defined as a situation where there are multiple episodes of mania under the case of hypomania and depression, will last for at least two years does not apply to the DSM criteria for major depression.
This situation is one of the bipolar disorders and address Bmthbtat mood medications mood stabilizing
Differential Diagnosis
Many of the psychological conditions can be simulated, and sometimes associated with bipolar disorder, which encompasses, schizophrenia, schizoaffective disorder, distress syndrome after trauma, alcohol abuse or Oalecoqaúan amphetamine and personality disorders such as narcissism, and the characters border and representativeness. In addition, the symptoms associated with episodes of mania are similar to several medical diseases include thyrotoxicosis, complex partial seizures, systemic lupus erythematosus, vascular injury and stroke, HIV, the third stage of syphilis, the symptoms of mood induced Balstroidat
The concept of bipolar II disorder spontaneously covers a broad spectrum of behaviors. Have expressed some interest about the effects resulting from the classification of psychological or social phenomena common medical classification, and on the leadership to provide large quantities of drugs psychological effect.
Rating:
Pharmaceutical story and the story and the full psychological evaluation of the patient are essential to start the diagnosis of bipolar disorder and to provide clear and the differential diagnosis when symptoms of mania.
Because of bipolar depression and mixed cases are associated with the dramatic rise in suicide rates, estimating the propensity for suicide is considered a necessary part of the evaluation.
Evaluation of the patient must include psychological screening with a special focus on the nervous system and glandular system. Must monitor the signs of alcoholism or other materials. Laboratory examination includes examination of thyroid gland stimulating hormone, a complete count of blood elements, chemical elements, and renal toxicity resulting from addiction to certain substances.
Additional tests, such as planning electric brain or brain imaging can be directed to the assets related to the story sick or clinical examination
Conclusion:
Bipolar disorder is a disease characterized by episodes high mood, people with the disease bipolar 1 disorder suffer from episodes of mania steadily. While patients with bipolar II disorder suffer from one or more bouts of severe depression with at least one of the episodes of hypomania. Patients with bipolar disorder have high rate of consumption of alcohol and drug addictive just like a anxiety disorder. Rate of suicide attempts (ranging between 25-50%) is more compared to patients with the first phase.
Must pay attention during the primary care doctor to the patient's symptoms, which was diagnosed unipolar depression, which could indicate he may have bipolar disorder II.
Patients with bipolar disorder are more likely to have a family history of bipolar disorder and to show they have in an early age.
Evaluation of patients with suspected bipolar disorder should include assessing the tendency to commit suicide and there is evidence of drug addiction.
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