Bipolar Disorder: Causes, Assessment

00:01 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.

00:14 Here are a few questions to post to you.

00:16 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.

00:33 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.

00:48 So what gene actually causes bipolar disorder? We think of this in terms of candidate genes.

00:55 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.

01:11 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.

01:27 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.

01:35 And also, the experimentation of illicit drugs, especially things that are excitatory, stimulating, things that increase dopamine in the brain, so thinking specifically of things like cocaine and stimulants.

01:48 This can really unmask a manic episode.

01:52 How about neurobiology? Because this is very important in the pathogenesis of bipolar disorder.

01:59 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.

02:16 And further, so can neuroimaging help with the understanding of how the disease develops? We actually think it can.

02:24 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.

02:46 Does inflammation play a role in developing bipolar? Yes, it does.

02:50 Inflammation is actually associated with immune system dysregulation and we find that there’s some correlation between this and the mood disorder.

03:01 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.

03:19 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.

03:34 You’re going to a physical exam and of course, being very attentive here to rule out general medical problems.

03:40 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.

03:50 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.

03:58 And you’re going to do some lab tests as well at baseline.

04:01 So you’re going to look at things like thyroid function, complete blood count, ruling out any kind of an illness.

04:08 You’re going to look at the kidneys, the liver.

04:10 You’re going to do a drug screen, of course.

04:13 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.

04:21 Fact to remember, a manic episode is a medical emergency.

04:25 And why you might ask? Well, this is because an individual’s judgment is severely impaired during that manic episode and that can really put someone at high risk for doing something dangerous and impulsive.

04:37 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.

04:52 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.

05:05 We’ll ask about risk factors for suicide.

05:07 You’re going to ask about family history, psychiatric symptoms, psychotic symptoms as well, and also any kind of other general medical disorders that could be contributing to this presentation.

05:20 You’ll also take a thorough medication list history from your patient.

05:25 Something important to consider in your bipolar assessment is getting collateral information.

05:31 So this means asking various objective neutral resources about your patient and of course, you’re doing this with your patient’s permission.

05:40 So some people you might want to get collateral from would be the patient’s family members, people who know them well.

05:46 You may want talk with their primary care doctor, with their outpatient psychiatrist, a former psychiatrist, with their therapist.

05:54 And all of these people will help you narrow down your diagnosis a little bit better and make a good management plan.