PROGRESSIVE MODALITIES AND COMPLICATIONS OF BIPOLAR DISORDERS

PROGRESSIVE MODALITIES AND COMPLICATIONS OF BIPOLAR DISORDERS Evolutionary modalities Evolution of manic access: ✪ In the absence of any treatment, it lasts 4 to 8 months. ✪ Under treatment, it lasts 3 to 6 weeks: the delusional component disappears first, then the excitement, the logorrhea and finally the dispersion of activity. ✪ Normalization of sleep is a good criterion for healing. EVOLUTION of bipolar disorder ✪ Bipolar disorder is an episodic illness with recurrences and free intervals. The duration of the episodes varies. The duration of depressive episodes is often longer than that of manic phases. ✪ The recurrence of mood episodes increases with the number of previous episodes. The frequency of episodes is variable, it increases during the first ten years of development before reaching a plateau. The frequency and length of the intervals is variable. They become increasingly reduced with the progression of the disease due to the increase in the frequency of attacks and the prolongation of their duration. ✪ There is diagnostic stability regarding TBI and TBII. 5 to 10% of patients develop into rapid-cycling bipolar disorder (more than 4 episodes per year). This development is facilitated by the prescription of antidepressants. Seasonality:cycles may be subject to seasonal influences. These are, typically, autonomic depressive attacks with remission or transformation into a manic attack in the spring.These seasonal disorders are more common in women and in Nordic countries. Special case of Bipolar II Disorder (TB II): ✪ Compared to TBI, TBII has the following characteristics: -earlier age of onset -women are more concerned -more recurrences, more chronicity and weaker remissions: half of their life is symptomatic, the duration of depressive symptoms is significantly longer than that of hypomanic symptoms -more frequent hospitalizations and more suicidal behavior linked to depressive episodes -more comorbidities: substance abuse, anxiety disorders, personality disorder.

Complications Suicide : This is the most formidable complication. This risk is estimated at 15-20% for untreated subjects. In bipolar disorder, the majority of suicides occur during depressive episodes. However, the risk of suicide is greater in bipolar disorder than in major depressive disorder. This risk is increased: -at the beginning of evolution -in forms with early onset -during depressive episodes, episodes with mixed or psychotic characteristics, manic turns on antidepressants. -during TBII, rapid cycle TB -by a family history of suicidal behavior -by comorbidity with anxiety disorders, addictive behaviors, a personality disorder (impulsive) -by a difficult family, social or professional situation -When there is a personal history of suicide attempts