Thread by @doc_santanu

(1/n) Today is #WorldBipolarDay 2023.
This is celebrated each year on 30th March to observe the birthday of Vincent Van Gogh, the famous painter who was posthumously diagnosed with #Bipolar Disorder.

Lets know what is #bipolardisorder & its #treatment
A 🧵
#Psychiatry

(2/n) Bipolar Disorder is a disorder of #mood that also affects our #thinking , perception, #behavior , decision making & thus hampers socio-occupational functioning.

A typical disorder consists of #depression , #mania or a mixture of both in varying types in its course.👇🏽

(3/n) A manic disorder is when there is:
persistent & pervasive elevated/ irritable #mood ➕
⬆️ energy & activity for > 7 days ➕
other sx like Grandiose claims, ⬆️self-esteem, engaging in risky endeavours + ⬇️sleep need etc
➕
Socio-occupational dysfunction.
#Psychiatry

(4/n) A softer/ milder variety of above (#mania) is Hypomania, wherein similar symps are present for at least > 4 days, that is observable, & which is not causing significant socio-occupational dysfunction.

Hypomania is often missed in clinical history & needs careful eliciting

(5/n) #Depression on the other hand presents with:
Persistent & pervasive low/ irritable #moods along with low energy & decreased interest & pleasure for > 14 days
➕
Other sx like pessimistic thoughts, ⬇️ self-esteem, helpless, hopeless & worthless feeling, #suicidal thoughts👇🏽

(6/n) Apart from above, #depression also causes ⬇️/⬆️ apetite & #sleep , ⬇️libido, & a plethora of bodily symptoms (which often masks an underlying depression!!).

As like manic disorder, depression also significantly hampers socio-occupational functioning of an individual.👇🏽

(7/n) Often, in an index episode of #bipolardisorder , a mixture of both #depression & #mania can be co-existing in varying proportions for a span of time (months?).

This is a Mixed episode, which also jeopardises individual thinking, feeling, decision making & functioning. 👇🏽

(8/n) For a #bipolardisorder to be diagnosed, the above episodes (#mania , #depression & #mixed) need to happen in various timespans of a person’s life in varying intensities, durations & proportions.
These episodes are separated by periods of full/ apparent remission. 👇🏽

(9/n) So what are the various presentations in #bipolardisorder ?
1. A single #manic episode
2. #mania , hypomania, #depression , mixed state in separate episodes in various permutations & combinations.
3. Recurrent #mania

A recurrent #depression only episodes is not ❌
👇🏽

(10/n) Anyone with such presentation should visit a #psychiatrist who:
1. Takes a careful history
2. Does a physical & #mental status examination
3. Advices some relevant investigations, &
4. Advices treatment option.

Treatment can be with drugs + therapy💊🩺👩‍⚕️👨‍⚕️

(11/n) Mood stabilizers are a group of drugs which are primarily indicated for #bipolardisorder 💊

These are very useful to manage an acute episode ➕ prevent a relapse.
They are:
1. #Lithium
2. Sodium valproate
3. Divalproex sodium
4. Carbamazepine/ Oxcbz
5. Lamotrigine
Etc

(12/n) Antipsychotics are often added to mood stabilizers to have a better & faster control of an acute episode.

The choice of a #mood stabilizer & antipsychotic depends on many factors:
1. The index episode type
2. Side effect profile
3. Rapidity of a response desired
4. Etc

(13/n) Often, when episode is severe enough that needs urgent management, or posing a severe threat to one’s own life/ others, apart from above treatment , a psychiatrist may also rationally & justly consider Electro-convulsive therapy (#ECT).

This is life-saving & safe.

(14/n) Apart from drugs, non-pharmacological treatments are also important in #bipolardisorder 👩‍⚕️
They can be as simple as basic psychoeducation about the disorder & treatment.
➕
Other #psychotherapy as deemed good by your psychiatrist/ clinical psychologist 👨‍⚕️👩‍⚕️🩺

(15/n) What’s actually important from a patient & caregiver perspective to gain adequate symptom control ➕functional improvement in #bipolardisorder is👇🏽
1. Early recognition
2. Early treatment seeking
3. Regular follow-ups
4. Adhering to treatment
5. Be watchful for triggers.

(16/16) This is in a nutshell the various manifestations & treatment options for #bipolardisorder 👆🏼

Today is World Bipolar Day 2023.

Lets break #stigma attached to this disorder & seek treatment.

You can visit @DepartmentAiims in @deoghar_aiims for further details & t/t.

@threadreaderapp to plz unroll.