So what are the causes of bipolar disorder?
Well, it’s not exactly known, but
like most psychiatric conditions,
we think it involves biological,
psychological, and social factors.
Here are a few questions to post to you.
When it comes to genetics,
what do you think about the inherited
factor of bipolar disorder?
Well, family and twin and adoption
studies actually demonstrate
that inherited factors are in fact
involved in the pathogenesis of bipolar.
We do see bipolar running
in families in my practice
when I meet somebody who qualifies
for a bipolar diagnosis,
usually they have a first degree
relative who’s had similar symptoms
whether it’s been formally
diagnosed or not.
So what gene actually
causes bipolar disorder?
We think of this in terms
of candidate genes.
So there’s not exactly one
gene we can pinpoint this on,
but rather it’s a constellation of
genes and things kind of going haywire
that tend to then manifest
as bipolar disorder
and make people susceptible to having this.
There are some psychosocial factors
that contribute to bipolar disorder
and these include things like advanced
paternal age, stressful life events,
childhood mistreatment, any form
of abuse, sleep deprivation.
So again, any kind of traveller work that
takes people out of their normal routine
is going to be a huge factor
and risk factor for bipolar.
And also, the experimentation
of illicit drugs,
especially things that are
things that increase
dopamine in the brain,
so thinking specifically of things
like cocaine and stimulants.
This can really unmask a manic episode.
How about neurobiology?
Because this is very important in the
pathogenesis of bipolar disorder.
So what do you think?
Do neurobiological factors affect bipolar?
Well, we think that brain structure
and function actually are altered
in the bipolar disorder
and we’ve see this
through scientific research with
functional magnetic resonance imaging.
And further, so can neuroimaging help with
the understanding of how
the disease develops?
We actually think it can.
Neuroscientists hypothesize that
early developmental processes
specifically pruning or the brain’s
ability to kind of rewire itself,
this modulates emotional behavior
and we think that the pruning ability
in neurodevelopment is actually altered
in people who go on to
experience bipolar disorder.
Does inflammation play a
role in developing bipolar?
Yes, it does.
Inflammation is actually associated
with immune system dysregulation
and we find that there’s some correlation
between this and the mood disorder.
So when you’re assessing
someone for bipolar,
you’re of course going to start with your
evaluation, taking a detailed history,
and really focusing also on
a patient’s family history
whether or not anyone in
the primary family has
had a bipolar diagnosis
or target symptoms of it.
And you’re of course going
to ask a little bit about
what medications have helped
or hurt your family member
because not only does the
illness run in families,
but we also tend to think that
treatments that are effective,
that work for one family
member will work for another.
You’re going to a physical
exam and of course,
being very attentive here to rule
out general medical problems.
So you’re going to do things
like take vital signs,
do a mental status exam as well
and you’re going to do a
full head to toe exam.
You might even get some consultations,
like a neurology consult
to help weigh in on whether or not this is
a medical cause or a psychiatric cause.
And you’re going to do some lab
tests as well at baseline.
So you’re going to look at
things like thyroid function,
complete blood count, ruling
out any kind of an illness.
You’re going to look at
the kidneys, the liver.
You’re going to do a
drug screen, of course.
So it’s also really
important to know that
you’re going to, in women,
do a pregnancy test
because this may help you modulate and
tailor your treatment a little bit.
Fact to remember, a manic
episode is a medical emergency.
And why you might ask?
Well, this is because an
is severely impaired
during that manic episode
and that can really put
someone at high risk
for doing something
dangerous and impulsive.
When you are taking the psychiatric
history and mental status exam,
you’re not only doing a thorough job
and history of bipolar illnesses
in the family and so forth,
but you’re also going to ask your patient
about any major depressive episodes.
You’re going to specifically ask them about
signs and symptoms
of mania, hypomania,
and of course, like with
every psychiatric interview,
you’re going to ask about
suicidal thoughts and behaviors.
We’ll ask about risk factors for suicide.
You’re going to ask about family history,
psychotic symptoms as well,
and also any kind of other
general medical disorders
that could be contributing
to this presentation.
You’ll also take a thorough medication
list history from your patient.
Something important to consider
in your bipolar assessment
is getting collateral
So this means asking various objective
neutral resources about your patient
and of course, you’re doing this
with your patient’s permission.
So some people you might
want to get collateral from
would be the patient’s family
members, people who know them well.
You may want talk with their primary care
doctor, with their outpatient psychiatrist,
a former psychiatrist,
with their therapist.
And all of these people will help you narrow
down your diagnosis a little bit better
and make a good management plan.