www.symbiosisonline.org Symbiosis www.symbiosisonlinepublishing.com 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 mania. 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 major depressive episode. 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, dysfunctionis that mania needs requires to be significant excluded. Durationalsocial 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 Thelifetime social risk and of economic around 2.6–7.8%, impact of andthe illnessits 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 bipolarcomponent, disorder with takes the severalinvolvement 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 influencesand socio includingenvironmental 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. as A numberin the offollowing 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