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Review article SOJ Psychology Open Access

Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Literatures Getinet Ayano* Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Received: September 30, 2016; Accepted: December 16, 2016; Published: December 28, 2016

*Corresponding author: Getinet Ayano, chief psychiatry professional and mhGap coordinator at Research and Training Department, Amanuel Mental Special- ized Hospital, Addis Ababa, PO box: 1971 Ethiopia, Tel:+251927172968; E-mail: [email protected]

unipolar disorder by including manic states. No matter how Abstract many times a patient is depressed; only one manic/hypomanic Bipolar affective disorder, or manic depressive Illness (MDI), is episode is required to diagnose bipolar rather than unipolar a common, severe, and persistent Mental illness. This condition is a disorder. Bipolar disorder is further characterized as type I or serious lifelong struggle and challenge. Bipolar affective disorder is type II. Type I is diagnosed when at least one manic episode is characterized by periods of deep, prolonged, and profound depression that alternate with periods of an excessively elevated or irritable mood 10 percent of cases there are no diagnosable major depressive known as . Only one manic/hypomanic episode is required to identified. Usually recurrent depression also occurs, but in 5 to diagnose bipolar rather than unipolar disorder. Bipolar disorder is further characterized as type I or type II. Type I is diagnosed when at episodes. Bipolar disorder type II requires the absence of even episodes, although almost always there will be minor depressive hypomanic episode and at least one . leastBipolar one manic disorder episode occurs is identified. in approximately 1 percent of the one manic episode, and instead the occurrence of at least one population. Bipolar II disorder and Bipolar disorder not otherwise

Bipolar disorder is almost always recurrent and can be associated The critical difference between mania and hypomania, in current withspecified severe (NOS) illness-related account for Morbidity another and 2.5 increased percent ofmedical the population. mortality. andDSM-V occupational nosology, dysfunction is that mania needs requires to be significantexcluded. Durational social and About 10 to 20 percent of patients with bipolar disorder die of their criteriaoccupational are less dysfunction, strict for hypomania while in hypomania (a minimum significant of 4 days) social than illness by suicide. for mania (a minimum of 1 week) [1]. Bipolar disorder is equally prevalent in men and women. It has an Bipolar disorder is common and disabling [2]. The hallmark early age onset. The most common age of onset of bipolar disorder is of the disorder is mood elevation (mania or hypomania) [1]. 1721 years. It is a highly disabling illness, and in fact a study. Patients with bipolar I disorder have episodes of mania and nearly always experience major depressive episodes. Patients genetic, perinatal, neuroanatomic, neurochemical and other biologic with bipolar II disorder suffer both hypomanic episodes and Bipolar disorder is caused by bio psychosocial influences including abnormalities. In addition psychological and socio environmental major depressive episodes. factors are associated with a greater risk of bipolar disorders. The role of genes in the susceptibility to mood disorders has long been It is one of the most severe of the psychiatric disorders. supported by family, twin, and adoption studies. That mood disorders Bipolar disorder is among the most disabling and economically run in families is a common observation of patients and clinicians. However, genes clearly only contribute a predisposition that must Organization as one of the common illnesses contributing to the interact with environmental factors in order to cause disease. globalcatastrophic burden medical of disease disorders, [3]. ranked by the World Health Treatment of bipolar disorders requires an integration of medical, psychological, and psychosocial inputs. onset and tendency to chronicity mean that its prevalence is Keywords: Bipolar; Mania; Hypomania; Cyclothymia; Mood relativelyIt carries high. a The lifetime social risk and of economic around 2.6–7.8%, impact of andthe illness its early is Stabilizers; Psychotherapy;

Background enormous, and its impact on sufferers and their families can be devastatingBipolar disorder [4, 5]. is a clinical diagnosis. It must be differentiated Bipolar disorder is characterized by manic or hypomanic states: the patient is either depressed, euthymic (normal in disorders such as heavy metal toxic mood), or hypomanic/manic. Bipolar disorder differs from from other psychiatric and medical illnesses, as well as from ity, adverse effects of drugs, and vitamin deficiencies [1]. Symbiosis Group *Corresponding author email: [email protected] Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright: Management: Review of Literatures © 2016 Ayano

Treatment of bipolar disorders requires an integration of disorder occur in families. Children whose biologic parents have medical, psychological, and psychosocial inputs. The bulk of either bipolar I disorder or a major depressive disorder remain at care occurs in an outpatient setting and is best carried out by a increased risk of developing an affective disorder, even if they are multidisciplinary team. Psychosocial rehabilitation is an essential reared in a home with adopted parents who are not affected [7,8]. part of treatment [1]. Linkage Studies: Etiology of bipolar disorders disorder have implicated many different chromosomal regions. Bipolar disorder, especiallyNumerous bipolar linkagetype I (BPI) studies disorder, of bipolar has a risk of developing bipolar disorders. Bipolar disorder is a disease Research has identified several factors that contribute to the geneticmajor genetic role in bipolar component, disorder with takes the several involvement forms. of the ANK3, neuroanatomic, neurochemical and other biologic abnormalities. CACNA1C, and CLOCK genes [9, 15]. The evidence indicating a Incaused addition by biopsychosocial psychological influences and socio including environmental genetic, factors perinatal, are Pregnancy and Birth Complications (Perinatal factors) associated with a greater risk of bipolar disorders [6, 7, 8]. An association between obstetric complications, structural Genetic factors brain abnormality and early onset schizophrenia has been reported in a number of investigations [16, 17] and reviewed Different studies indicated that bipolar disorders have high genetic transmission risks. Some of evidences for genetic obstetric complications may share a common pathophysiology, transmission of bipolar disorders are: namelyrecently foetal[12]. Although hypoxia broadly [18]. Studies defined have or apparently demonstrated unrelated, that Family Studies: Studies indicate that bipolar disorders run patients with bipolar disorder have increased rates of obstetric in families. First degree relatives of people with bipolar I disorder complications and this was associated with an early illness onset are approximately 7 times more likely to develop bipolar I [19]. By contrast, little research has been carried out into the disorder than the general population. Remarkably, offspring relationship between obstetric complications and age of onset of of a parent with bipolar disorder have a 50% chance of having bipolar affective disorder. However, increased risks of perinatal another major psychiatric disorder. One longitudinal study birth complications have also been reported in bipolar disorder found that sub threshold manic or hypomanic episodes were a diagnostic risk factor for the development of subsequent manic, bipolar disorder is still unclear; Scott’s review and metanalysis mixed, or hypomanic episodes in the offspring of parents with [20-25]. The significance of such findings in the causation of bipolar disorder. In fact, unipolar disorder is typically the most obstetric complications and bipolar disorder. common form of mood disorder in families of bipolar probands. of literature [24] failed to find a significant association between However, the rate of bipolar disorder is only slightly elevated in Neurotransmitters (Biochemical factors) the families of unipolar probands. This familial overlap suggests Multiple biochemical pathways likely contribute to bipolar some degree of common genetic underpinnings between these disorder, which is why detecting one particular abnormality is two forms of mood disorder [6]. disorder, largely based on patients’ responses to psychoactive Twin Studies: Twins who are reared together share the same agentsdifficult. asA number in the of following neurotransmitters examples. have The been blood linked pressure to this environment, but monozygotic (MZ) twins share all their genes, drug reserpine, which depletes catecholamines from nerve while Dizy Gotic (DZ) twins share on average only 50 percent. terminals, was noted incidentally to cause depression. This led Twin studies compare the concordance rates in MZ and DZ twins. to the catecholamine hypothesis, which holds that an increase in The concordance rate refers to the proportion of co-twins who epinephrine and nor epinephrine causes mania and a decrease are also affected or to the proportion of twin pairs where both in epinephrine and nor epinephrine causes depression. Drugs twins are affected. Twin studies demonstrate a concordance used to treat depression and drugs of abuse (e.g., cocaine) of 3390% for bipolar I disorder in identical twins. As identical that increase levels of monoamines, including serotonin, nor epinephrine, or dopamine, can all potentially trigger mania, environmental factors are involved, and there is no guarantee implicating all of these neurotransmitters in its etiology. Other thattwins a share person 100% will develop of their bipolar DNA, these disorder, studies even also if they show carry that agents that exacerbate mania include L-dopa, which implicates susceptibility genes [7, 8]. dopamine and serotoninre uptake inhibitors, which in turn Adoption Studies: Adoption studies provide an alternative implicate serotonin. Evidence is mounting of the contribution approach to separating genetic and environmental factors in of glutamate to both bipolar disorder and major depression. A familial transmission. Adoption studies have been conducted postmortem study of the frontal lobes of individuals with these using a variety of experimental designs, but the most common is disorders revealed that the glutamate levels were increased [26]. the adoptee as proband strategy. In this approach, probands are Recent life events and bipolar disorder (Environmental Through this event, nature is separated from nurture. The rates factors) ofidentified psychiatric who illness have a are mood then disorder determined and were in both adopted the biological at birth. Overall, studies of life events have found that bipolar individuals experience increased stressful events prior to common environment is not the only factor that makes bipolar and adoptive parents. Numerous adoption studies prove that a first onset and recurrences of mood episodes. Moreover, Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 2 of 8 Literatures. SOJ Psychol 3(1): 1-8. Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright: Management: Review of Literatures © 2016 Ayano

most studies have found that negative life events precede the symptoms meet the criteria for a fully syndromal manic episode manic/hypomanic as well as the depressive episodes of bipolar also experience major depressive episodes during the course of their lives (table 1). bipolar patients experienced at least one stressful event rated as independentindividuals. Numerous of their behavior studies indicatein the 1–3month that from period20% to prior 66% toof Bipolar II disorder onset of a mood episode . In additions psychosocial stressors are Bipolar II disorder, requiring the lifetime experience of at the major causes of relapse in bipolar patients [27, 28]. least one episode of major depression and at least one hypomanie Epidemiology episode, is no longer thought to be a “milder” condition than bipolar I disorder, largely because of the amount of time Global prevalence of Bipolar disorder individuals with this condition spend in depression and because Bipolar disorder was equated with classic manic depressive the instability of mood experienced by individuals with bipolar II (i.e., bipolar I) disorder, and the lifetime prevalence of bipolar disorder is typically accompanied by serious impairment in work disorder was found to be approximately 1%. However, if and social functioning (table 2.) the diagnosis of bipolar II disorder (major depression with Cyclothymic disorder hypomania, but not with mania) is much higher lifetime The diagnosis of cyclothymic disorder is given to adults who experience at least 2 years (for children, a full year) of both Coprevalence morbidity rates Survey of the Replication broadly defined has shownbipolar that disorders, the lifetime up to prevalenceat least 5%, estimates were reported. were Studies The recent also results indicate of differences the National in criteria for an episode of mania, hypomania, or major depression hypomanie and depressive periods without ever fulfilling the lifetime prevalence estimates for bipolar disorder type I (BPI) (table 3). (1.0%), bipolar disorder type II (BPII) (1.1%), and sub threshold Management of bipolar disorders bipolar disorders (2.44.7%)[29]. Although mood stabilizers are the mainstay of the treatment Socio demographic factors for bipolar disorders, research has found that psychosocial The gender ratio in bipolar disorder (all subtypes combined) interventions, including psychotherapy, can augment the clinical is approximately 1:1. However, among bipolar II patients and improvement. Just as pharmacological agents are used to treat in special subpopulations (mixed/dysphoric mania, mixed presumed chemical imbalances, no pharmacological strategies depressive episode, winter depression, bipolar depression with must treat no biological issues. The complexity of bipolar atypical clinical features, and rapid cycling bipolar disorder), disorders usually renders any single therapeutic approach women are overrepresented. Looking at the depression–mania inadequate to deal with the multifaceted disorder. Psychosocial continuum as a whole spectrum, there is a clear trend: The higher modalities should be integrated into the drug treatment regimen the depressive component, the higher the proportion of women. Consequently, in the rare cases of unipolar mania (manic episode more from the combined use of mood stabilizers and psychosocial without any major or minor depression), men are markedly treatmentand should than support from either it. Patients treatment with used bipolar alone disorders [36]. benefit overrepresented. The gender differences in lifetime prevalence Pharmacological managements rates are more marked than in 1year and current prevalence rates, which may be attributable—at least in part—to the A number of medications are used to treat bipolar disorder stronger male tendency to forget previous episodes and deny [31, 39] including: emotionally negative events [30]. Mood stabilizers Diagnosing of bipolar disorders (Current Anti-psychotics Diagnostic Criteria- DSM-5) • Anti-depressants Seven bipolar disorder categories are included in DSMV: • bipolar I disorder, bipolar II disorder, cyclothymic disorder, • Anti-anxiety medications substance/medication induced bipolar and related disorder, Most people with bipolar I or bipolar II will need mood bipolar and related disorder due to another medical condition, • stabilizers to control their manic or Hypomanic episodes. Commonly used moods stabilizers include: bipolar and related disorder [1]. other specified bipolar and related disorder, and unspecified Tegretol (carbamazepine) Bipolar I disorder Depakote (divalproex sodium., valproic acid) The bipolar I disorder criteria represent the modern • understanding of the classic manic depressive disorder or affective • Lamictal (lamotrigine) described in the nineteenth century, differing from Lithobid (lithium) that classic description only to the extent that neither psychosis • nor the lifetime experience of a major depressive episode is a Antipsychotic• drugs may also be used to control episodes of requirement. However, the vast majority of individuals whose depression or mania, especially when delusions or hallucinations

Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 3 of 8 Literatures. SOJ Psychol 3(1): 1-8. Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright: Management: Review of Literatures © 2016 Ayano are occurring. Examples of drugs in this class include: Saphris (asenapine) Abilify (aripiprazole) • • • Symbyax (olanzapine and fluoxetine) Table 1: DSM-V Diagnostic Criteria for bipolar I disorder DSM-V Diagnostic Criteria for bipolar I disorder For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes. Manic Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least 1 Week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only

2.irritable) Decreased are needpresent for tosleep a significant (e.g., feels degree rested and after represent only 3 hours a noticeable of sleep). change from usual behavior: 3.1. MoreInflated talkative self esteem than orusual grandiosity. or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal directed activity (either socially, at work or school, or sexually) or (i.e., purposeless non goal directed activity). 7. Excessive involvement in activities that have a high potential for painful consequence (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C prevent harm to self or others, or there are psychotic features. D.. TheThe moodepisode disturbance is not attributable is sufficiently to the severe physiological to cause effects marked of impairmenta substance (e.g.,in social a drug or occupationalof abuse, a medication, functioning other or to treatment) necessitate or hospitalization to another to medical condition. Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully

Major Depressive Episode A.syndromal Five (or levelmore) beyond of the followingthe physiological symptoms effect have of thatbeen treatment present during is sufficient the same evidence 2 week for period a manic and episode represent and, a therefore,change from a bipolar previous I diagnosis. functioning; at least one of the symptoms is either (1) Depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation madeNote: Doby othersnot include (e.g., symptomsappears tearful). that are clearly attributable to another medical condition.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account orNote: observation). In children and adolescents, can be irritable mood.

appetite nearly every day. 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than5% of body weight in a month), or decrease or increase in 4. Insomnia or hypersomnia nearly every day. 5.Note: Psychomotor In children, agitation consider or failure retardation to make nearly expected every weight day (observable gain. by others; not merely subjective feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

committing suicide. B.9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for C. The episode is not attributable to the physiological effects of a substance or another medical condition. Note: The Criteria symptoms A constitute cause clinically a major significant depressive distress episode. or Majorimpairment depressive in social, episodes occupational, are common or other in bipolar important I disorder areas butof functioning. are not required for the diagnosis of bipolar I disorder. Note: include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive Responses episode. to a Althoughsignificant such loss symptoms (e.g., bereavement, may be understandable financial ruin, losses or considered from va naturalappropriate disaster, to the a seriousloss, the medical presence illness of a majoror disability) depressive may

clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss. Bipolarepisode inI Disorder addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of A. Criteria have been met for at least one manic episode (Criteria AD under “Manic Episode” above). B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia,

schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 4 of 8 Literatures. SOJ Psychol 3(1): 1-8. Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright: Management: Review of Literatures © 2016 Ayano

Table 2: DSM-V Diagnostic Criteria for bipolar II disorder

DSM-V Diagnostic Criteria for bipolar II disorder For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanie episode and the following criteria for a current or past major depressive episode: Hypomanie Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy and activity, three (or more)of the following symptoms have persisted (four if the

1. 2mood. Decreased is only irritable),need for sleep represent (e.g., feels a noticeable rested after change only from 3 hours usual of behavior, sleep). and have been present to a significant degree: 3. MoreInflated talkative self esteem than usualor grandiosity. or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation. 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment). Note:psychotic A full features, hypomanie the episode episode is, thatby definition, emerges duringmanic. antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully

is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanie episode diagnosis. However, caution Bipolar II Disorder A.sufficient Criteria for have diagnosis been metof a hypomaniefor at least episode,one hypomanie nor necessarily episode indicative(Criteria AFof aunder bipolar “Hypomanic diathesis. Episode” above) and at least one major depressive episode (Criteria AC under “Major Depressive Episode” above). B. There has never been a manic episode. C. The occurrence of the hypomanie episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia,

D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

significant distress or impairment in social, occupational, or other important areas of functioning. Table 3:DSM-V Diagnostic Criteria for Cyclothymic Disorder

DSM-V Diagnostic Criteria for Cyclothymic Disorder A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. B. During the above 2year period (1 year in children and adolescents), the hypomania and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. C. Criteria for a major depressive, manic, or hypomanie episode have never been met. D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,

E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)or other specified orcourse. unspecified schizophrenia spectrum and other psychotic disorder.

Table 4: Most commonly used mood stabilizers and indications

Agent Indications or preferred to use

Euphoric, pure(classic )mania, no psychosis, no rapid Cyclic previous good personal or family response and sequence of mania- Lithium depression-euthemia.

Valproate Irritable mania, mixed episode, rapid cycling, secondary mania, comorbid substance use, severe with psychosis

Carbamazepine History of trigeminal neuralgia, comorbid post traumatic stress disorders, comorbid substance issues, Severe mania( with psychosis), comorbid anxiety and panic attack, commorbid migraine headache, Irritable mania Olanzapine FDA approved for acute and maintenance treatment for mania.

Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 5 of 8 Literatures. SOJ Psychol 3(1): 1-8. Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Copyright: Management: Review of Literatures © 2016 Ayano

Latuda (lurasidone) management and/or intervention with user. Family intervention for individuals diagnosed with bipolar Zyprexa (olanzapine) • disorder has the identified service the emotional environment within a family was an effective • Seroquel (quetiapine) predictor of relapse.developed In this outcontext, of the‘family’ consistent includes finding people who that Risperdal (risperidone) • emotional connection to the individual, such as parents, siblings and partners. Different models of family • Geodon (ziprasidone) interventionhave a significant aim to help families cope with their relative’s An antidepressant may also be used to manage depressive • problems more effectively, provide support and education for the episodes, in conjunction with a mood stabilizer or an family, reduce levels of distress, improve the ways in which the antipsychotic. family communicates and negotiates problems, and try to prevent Finally, Benzodiazepines Diazepam, Lorazepam, Clonazepam relapse by the service or another type of anti anxiety medication may be used. supportive or treatment function based on systemic, cognitive behavioral or psychoanalyticuser [51]. principles, Family sessions which with must a specific contain Psychosocial interventions at least one of the following psycho educational intervention, Psycho education and more formal psychotherapy can problem solving/crisis management work and intervention with improve outcome when used in conjunction with maintenance the pharmacotherapy. Adjunctive psychosocial therapies should be Interpersonal and social rhythm therapy (IPSRT): considered early in the course of illness to improve medication identified patient. adherence, identify prodromes of relapse, decrease residual as discrete, time limited, structured psychological intervention symptoms (particularly depressive) and suicidal behavior, derivedInterpersonal from an and interpersonal social rhythm model therapy of affective (IPSRT) disorders was defined [52, and help move patients towards a comprehensive functional 53]. It focuses on: recovery [40–46]. For bipolar disorders Psychological and social (psychosocial) interventions are important in addition to • Working collaboratively with the therapist to identify the continuing on medication. These may include: effects of key problematic areas related to interpersonal Psycho educational interventions include Psycho education: and their effects on current symptoms, feelings states any discrete programme involving interaction between an and/orconflicts, problems role transitions, grief and loss, and social skills, information provider and service users or their careers which has the primary aims of offering information about the condition • Seeking to reduce symptoms by learning to cope with or and the provision of support and management strategies. resolve these interpersonal problem areas Complex Seeking to improve the regularity of daily life in order to involving an explicitly described educational interaction between minimize relapse. the informationpsycho education provider was and defined the patient/carer as any group as programme the prime focus of the intervention [47, 48]. 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Citation: Ayano G (2016) Bipolar Disorder: A Concise Overview of Etiology, Epidemiology Diagnosis and Management: Review of Page 8 of 8 Literatures. SOJ Psychol 3(1): 1-8.