Professional Documents
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2013, 4 (6)
INTERNATIONAL RESEARCH JOURNAL OF PHARMACY
www.irjponline.com ISSN 2230 8407
Review Article
Article Received on: 10/03/13 Revised on: 21/04/13 Approved for publication: 13/05/13
DOI: 10.7897/2230-8407.04608
IRJP is an official publication of Moksha Publishing House. Website: www.mokshaph.com
All rights reserved.
ABSTRACT
Bipolar disorder is a chronic illness, which may require life-long treatment. Patients will spend 3-5 times more days in the depressed episode then in the manic
phase. Due to this variability in episodes, polypharmacy is used quite frequently in practice, though the evidence to do this remains quite limited. Many
positive and negative outcomes can occur from this practice. Bipolar disorder is the 6th leading cause of disability in the developed world among those
between the ages 15 and 44 years age groups. Serotonin is one of the neurotransmitter in the brain, and one of that strongly affects the person mood.
Clozapine (clozaril), olanzapine (zyperexa), risperidone (Risperdal), and ziprasidone (zeldox) and the clozapine may be helpful as mood stabilizer for people
who do not respond to lithium and anticonvulsant.
Keywords: Bipolar disorder, Mania, Types of bipolar disorder.
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Yadav Jaya et al. Int. Res. J. Pharm. 2013, 4 (6)
twins (where a child whose biological parent had the illness neuroimaging studies are being conducted to learn more
is raised in an adoptive family untouched by the illness) has about bipolar disorder Lesions in the frontal and temporal
helped researchers. Researchers conclude that the lifetime lobes are most frequently associated with bipolar disorder.
chance of an identical twin (of a bipolar twin) to also develop Left-sided lesions tend to be associated with depression and
bipolar disorder is about 40% to 70%.In more studies at right-sided lesions with mania, though differences may be
Johns Hopkins University, researchers interviewed all first- reversed in the posterior regions of the brain (e.g., the
degree relatives of patients with bipolar I and bipolar II association of depression with right parietooccipital lesions).
disorder and concluded that bipolar II disorder was the most No abnormalities have been found consistently via computed
common affective disorder in both family sets. The tomography (CT) studies, though ventricular enlargement has
researchers found that 40% of the 47 first-degree relatives of been suspected. Magnetic resonance imaging (MRI) studies
the bipolar II patients also had bipolar II disorder; 22% of the reveal an increase in white matter intensities associated with
219 first-degree relatives of the bipolar I patients had bipolar bipolar disorder and correlated with age, though the clinical
II disorder Studies at Stanford University that explored the significance is unknown. Overall, most functional imaging
genetic connection of bipolar disorder found that children studies (single-photon emission computer tomography
with one biological parent with bipolar I or bipolar II disorder [SPECT] and positron emission tomography [PET]) have
have an increased likelihood of getting bipolar disorder. In noted prefrontal and anterior paralimbic hypoactivity in
this study, researchers reported that 51% of the bipolar bipolar depression, while preliminary studies of manic
offspring had a psychiatrhiatric disorder, most commonly patients have yielded inconsistent findings7.
major depression, dysthymia (mild depression), bipolar
disorder, or attention deficit hyperactivity disorder (ADHD). Environmental factors in Bipolar Disorder
Interestingly, the bipolar parents in the study who had a A life event may trigger a mood episode in a person with a
childhood history of ADHD were more likely to have genetic disposition for bipolar disorders. Even without clear
children with bipolar disorder but not ADHD. genetic factors, altered health habits, alcohol or drug abuse or
Bipolar disorder is frequently inherited, with genetic factors hormonal problems can trigger an episode. Among those at
accounting for approximately 80% of the cause of the risk for the illness, bipolar disorder is appearing at
condition. If one parent has bipolar disorder, there is a 10% increasingly early ages. This apparent increase in earlier
chance that his or her child will develop the illness. If both occurrences may be due to under diagnosis of the disorder in
parents have bipolar disorder the likelihood of their child the past. This change in the age of onset may be a result of
developing the illness rises to 40%. However, just because social and environmental factors that are not yet understood.
one family member has the illness, it is not necessarily the Although substance abuse is not considered a cause of bipolar
case that other family members will also develop the illness. disorder, it can worsen the illness by interfering with
The following factors might also be involved in the onset of recovery. Use of alcohol or tranquilizers may induce a more
bipolar disorder. severe depressive phase. While the onset of bipolar disorder
may be linked to a stressful life event, it is unlikely that stress
Neurochemical factors in Bipolar Disorder itself is a cause of bipolar disorder. Notwithstanding this,
Three important brain chemicals are noradrenalin, people who suffer from bipolar disorder often find it
(norepinenephrine), serotonin, and dopamine. Norepinephrine beneficial to find ways of managing and reducing stress in
and 5 hydroxytrytamin(serotonin) have been consistently their lives (as do people without the disorder! Again - while
linked to psychiatric mood disorder such as depression and not a cause - seasonal factors appear to play a role in the
bipolar depression the brain chemical serotonin is connected onset of bipolar disorder, with onset chance increasing in
to many body functions, sleep wakefulness, eating sexual spring. The rapid increase in hours of bright sunshine is
activity, learning, and memory. Biochemical imbalance in the thought to trigger depression and mania by affecting the
brain that makes a person vulnerable to experiencing mood pineal gland.
episodes. A recent theory about cause of bipolar disorder is
that is related to abnormal serotonin chemistry in the brain. Symptoms of Bipolar Disorder
Serotonin is one of the neurotransmitter in the brain, and one In bipolar disorder it is a combination of depressive and
of that strongly affects the person mood. An imbalance is manic episodes. Firstly, the symptoms of mania:
thought to be caused by irregular hormone production or Increased of energy level, activity, and restlessness
certain neurotransmitter, which act as a messenger between Excessive high- euphoric mood
nerves cell. New research has found stress hormone may Extreme irritability
change the way gene function, allowing illness like bipolar Talking very fast
disorder to emerge4 brain imaging studies are helping Distractibility, cant concentrate well
scientist learn what goes wrong in the brain to produce Unrealistic beliefs
bipolar disorder and other mental illness5,6. New brain Poor judgement
imaging techniques allows researchers to take pictures of
Increased sexual drive
living brain at work, to examine it structure and activity,
without the need for surgery or other invasive procedure .this
Symptoms of depressive episode
technique include magnetic resonance imaging (MRI),
Lasting sad, anxious, or empty mood
positron emission tomography (PET), and functional
magnetic resonance imaging (f MRI). There is evidence that Feeling hopelessness and pessimism
images of brain of people have bipolar disorder is different Feeling guilt, worthlessness, or helplessness
from healthy people. As a biological disorder, it may lie Loss of interest or pleasure activities once enjoyed
dormant and be activated on its own or it may be triggered by Decreased energy, feeling of fatigue
external factors such as psychological stress and social Difficulties in concentrating, remembering, making
circumstances. A wide range of neuroanatomical and decisions
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Yadav Jaya et al. Int. Res. J. Pharm. 2013, 4 (6)
Restlessness or irritability Types of mania and response to medication
Sleeping too much or cant sleep Patients with euphoric or pure mania respond to lithium
Change appetite, or weight loss or gain between 59 and 91 percent of the time, and at slightly lower
Thought of death or suicide, or suicide attempts rates to valproate treatment9.
Dysphoric or mixed- It is severe type, and difficult to
treat. A review of studies revealed associations with
suicidality, an earlier age of onset, their episode is longer
duration, and higher rates of personal and family
depression, higher concomitant alcohol or sedative-
hypnotic abuse, more neuropsychiatric abnormalities,
their poorer outcome10. Patients in acute episodes of
mixed mania respond better to valproate than lithium.
Most atypical antipsychotics have an indication, too, for
mixed mania, though combinations are often needed.
Rapid cycling- Cycling ranges from four or more per year
Types of Bipolar Disorder (rapid cycling: 1520%) they occurred from weeks to
There are four types of bipolar disorder bipolar I, bipolar II, several days (ultra-rapid cycling) to distinct, abrupt shifts
cyclothymia and bipolar disorder not otherwise specified and less than 24 hours (ultradian cyclers) 11. Cyclers are
(BP-NOS). more likely to be female, have associated
hypothyroidism12, and lower likelihood of recovery in the
Bipolar-I disorder second year of follow-up, but not permanently. It may be
In bipolar- I disorder, the person has manic episodes and a parameter of treatment resistance, in general, with many
almost always experience depression at some stages. This patients not responding even to combinations of mood
occurs at least seven days, or by manic symptoms that are so stabilizers. Conceptually, treatment parallels mixed
severe that the person needs immediate hospital care. episodes. In acute episodes, patients with a rapid cycling
Usually, the person also has depressive episodes, typically pattern appear to respond better to
lasting at least two weeks. Bipolar disorder is the severe quetiapine, lamotrigine, or valproate. Other treatment
disorder, in this case the patients are more likely to options include adding thyroid hormone to a mood
experience mania, have longer highs. In this disorder the stabilizer (at a dose to achieve 150% of normal function)
people have experienced one or more episodes of mania, using a combination of standard mood stabilizers,
most people experienced both mania and depression and few clozapine as a monotherapy, and clozapine in
people have episodes of mania alone. combination with lithium or valproate.
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