Presentation
Part of this is attributable to the depth and duration of depressive episodes so often present in bipolar 2 diagnoses. [brightquest.com]
The two most common types, bipolar I and bipolar II, differ in the presentation of mood variations. The course of bipolar II is less well studied and less understood than bipolar I disorder. [medscape.com]
Bipolar disorder is categorized into two separate types of disorders that are differentiated by the type of manic-like behaviors presented by the person. Bipolar I occurs when the person presents with a formal manic episode. [americanaddictioncenters.org]
Types I and II present equally severe burdens. [1] [9] Bipolar II is notoriously difficult to diagnose. [en.wikipedia.org]
Like bipolar I, issues with school and careers are also present. Truancy or failure in school and occupational failure are common. Divorce is also very common in bipolar individuals. [courses.lumenlearning.com]
Entire Body System
- Hunting
Mood Genes: Hunting for Origins of Mania and Depression by Samuel W. Barondes, M.D. New York, W.H. Freeman and Co, 1998. Skywriting by Jane Pauley. Random House, 2004. [checkupfromtheneckup.ca]
"Hasty and Ruinous 1972 Pick Colors Today's Hunt for a No. 2". The New York Times. Retrieved June 24, 2017. ^ "Carie Fisher 'Strike Back' at Mental Illness". [en.wikipedia.org]
[…] comorbid disorders have a much greater burden of illness than other patients, with sequelae including delayed recovery from mood episodes, increased suicidality, functional impairment, decreased medication adherence and decreased quality of life 70 Hunt [tandfonline.com]
- Pressured Speech
speech, and other symptoms. [mindyra.com]
They can be depressed, irritable, have pressured speech, and act in very irrational and impulsive ways. [youtube.com]
- Rigor
The CDS raters regularly undergo rigorous training and monitoring, resulting in high intraclass correlation coefficients (ICCs) for rating changes in symptoms (ICC = 0.92), recovery from episodes (ICC = 0.95), and subsequent reappearance of symptoms [jamanetwork.com]
- Goiter
Long-term adverse effects of lithium include nephropathy, hypothyroidism, goiter, and possibly cardiac rhythm disturbances, especially in patients with pre-existing cardiac disease. 1,5 Anticonvulsants Anticonvulsants are used in the treatment of bipolar [uspharmacist.com]
Hematological
- Easy Bruising
bruising, tremor, GI discomfort (less in divalproex), hepatic failure, thrombocytopenia, pancreatitis Antipsychotics Aripiprazole 10–30 mg daily Usual target dose : 15–45 mg per day Headache, N/V, constipation, insomnia, akathisia Haloperidol 5–15 mg [medscape.com]
Gastrointestinal
- Dyspepsia
[…] in 2 divided doses Headache, dry mouth, constipation, weight gain, sedation, dizziness, orthostatic hypotension Risperidone 1–2 mg once or twice daily Usual target dose: 4–8 mg once at bedtime or twice daily Elevated prolactin, akathisia, sedation, dyspepsia [medscape.com]
Cardiovascular
- Heart Disease
It’s important to seek treatment for these conditions as you seek treatment for bipolar II disorder: Anxiety disorders Attention-deficit/hyperactivity disorders Alcohol or drug abuse Chronic health conditions like heart disease, thyroid problems or obesity [baptisthealth.com]
Examples include: Anxiety disorders Eating disorders Attention-deficit/hyperactivity disorder (ADHD) Alcohol or drug problems Physical health problems, such as heart disease, thyroid problems, headaches or obesity Prevention There's no sure way to prevent [mayoclinic.org]
- Orthostatic Hypotension
hypotension Quetiapine 100 to 200 mg once or twice daily Usual target dose: 400–800 mg (or up to 1,200 mg) at bedtime or in 2 divided doses Headache, dry mouth, constipation, weight gain, sedation, dizziness, orthostatic hypotension Risperidone 1–2 mg [medscape.com]
Skin
- Pruritus
[…] impaiment, renal impairment, thyroid disorder, cardiac rhythm disturbances Anticonvulsants Carbamazepine 100–200 mg daily divided into once or twice daily doses Usual target dose : 800–1,000 mg daily in divided doses N/V, diarrhea, hyponatremia, rash, pruritus [medscape.com]
This justifies the slow increase in dose as therapy continues. 2,26,27 Side Effects: Side effects include nausea, vomiting, diarrhea, hyponatremia, rash, pruritus, leukopenia, fluid retention, and neurotoxicity, which may manifest as drowsiness, dizziness [uspharmacist.com]
Psychiatrical
- Flat Affect
However, treatment with mood stabilizers may produce a flat affect in the patient, which is dose-dependent. [en.wikipedia.org]
- Emotional Outbursts
My outbursts would manifest themselves as middle-of-the-night getaways, and verbal assaults. In the seconds after my emotional explosions, my gut reaction was to run and hide ─ lock myself away in a bathroom, car, or closet. [psycom.net]
- Type A Personality
Read on to learn how these two types are alike and different. All types of bipolar disorder are characterized by episodes of extreme mood. The highs are known as manic episodes. The lows are known as depressive episodes. [healthline.com]
Urogenital
- Polyuria
Agents Used for Bipolar II Disorder Class Agent Dosing Common Side Effects Mood stabilizers Lithium 300 mg bid-tid Usual target does : 900–1,800 mg daily in divided doses (renally adjust) Nausea, tremor, polyuria, thirst, weight gain losse stools, cognitive [medscape.com]
Side Effects: The most common acute side effects include nausea, tremor, polyuria and thirst, weight gain, loose stools, and cognitive impairment. 12,18,19 Any exacerbation of these side effects may indicate lithium toxicity and should be addressed. [uspharmacist.com]
[…] occur when lithium plasma levels change rapidly and should be anticipated when doses are increased. 16 Lithium overdose can cause chronic neural toxicity and may even be fatal. 16 Lithium reduces the ability of the kidneys to concentrate urine causing polyuria [bpac.org.nz]
Neurologic
- Extrapyramidal Symptoms
symptoms; GI: gastrointestinal; N/V: nausea and vomiting. [medscape.com]
Although individual antipsychotic agents are associated with different propensities for causing specific adverse events, common effects associated with atypical antipsychotics include weight gain, extrapyramidal symptoms, sedation and metabolic dysfunction [tandfonline.com]
- Akathisia
Haloperidol 5–15 mg daily in 1 or 2 divided doses or 0.2 mg/kg per day EPS, akathisia, tardive dyskinesia Olanzapine 10–15 mg daily Usual target dose: 10–30 mg (or up to 50 mg) daily at bedtime or in 2 divided doses Sedation, constipation, dry mouth, [medscape.com]
Workup
Serum
- Hyponatremia
[…] stools, cognitive impaiment, renal impairment, thyroid disorder, cardiac rhythm disturbances Anticonvulsants Carbamazepine 100–200 mg daily divided into once or twice daily doses Usual target dose : 800–1,000 mg daily in divided doses N/V, diarrhea, hyponatremia [medscape.com]
This justifies the slow increase in dose as therapy continues. 2,26,27 Side Effects: Side effects include nausea, vomiting, diarrhea, hyponatremia, rash, pruritus, leukopenia, fluid retention, and neurotoxicity, which may manifest as drowsiness, dizziness [uspharmacist.com]
Treatment
Treatments for bipolar II disorder vary. There are only a few treatment guidelines aimed at this type of bipolar disorder. Most guidelines suggest using the same medications as for bipolar I disorder. [bbrfoundation.org]
Bipolar 2 Treatment at BrightQuest BrightQuest Treatment Centers provide world-class residential treatment for bipolar disorder and other complex mental illnesses. [brightquest.com]
Lithium treatment also showed an initial delay in symptom improvement for both bipolar subtypes, but by 8 weeks approached a similar symptom improvement to quetiapine treatment. [annals-general-psychiatry.biomedcentral.com]
The overall treatment response was 62.7%, and 14% of patients experienced a switch to hypomania (12%) or severe hypomania (2%), typically within the first 5 weeks after treatment initiation. [psychiatryadvisor.com]
Unfortunately, relatively little attention has been given to treatment of BP II. Concern that patients may switch from depressed to manic states during treatment of MDE has impeded the development of effective treatments for BP II MDE. [clinicaltrials.gov]
Prognosis
[…] are unique to each individual. [4] As with bipolar I disorder, the interval between episodes seems to decrease with age, though approximately 5% to 15% of patients experience rapid cycling. [4] The more episodes a patient experiences, the poorer the prognosis [medscape.com]
Prognosis Proper diagnosis and treatment help people with bipolar II disorder lead healthy and productive lives. [baptisthealth.com]
[…] with Bipolar II, much more so in women than in men (70% vs. 40%), and without treatment leads to added sources of disability and an increased risk of suicide. [19] To improve a patient’s prognosis, long-term therapy is most favorably recommended for [en.wikipedia.org]
This condition is often difficult to diagnose and may shade into a continuously cycling state; the prognosis is worse than that in a pure manic or hypomanic state. Risk of suicide during mixed episodes is particularly high. [msdmanuals.com]
[…] that are unique to each individual. 4 As with bipolar I disorder, the interval between episodes seems to decrease with age, though approximately 5% to 15% of patients experience rapid cycling. 4 The more episodes a patient experiences, the poorer the prognosis [uspharmacist.com]
Etiology
Etiology Genetics play a big factor of people with bipolar 2 disorder. Individuals with family members that have bipolar 2 disorders have a big risk of bipolar 2. [courses.lumenlearning.com]
[…] particular focus on neurologic and endocrine systems, signs of substance abuse, symptoms of trauma to the CNS, and laboratory testing (including thyroid testing, CBC, blood chemistries, and urine toxicology testing), should be conducted to rule out other etiologies [uspharmacist.com]
Epidemiology
This is the only academic and clinical management review focused entirely on bipolar II, scrutinizing history, epidemiology, burden and neurobiology and including an extensive clinical debate by international experts about effective management strategies [cambridge.org]
The National Comorbidity Survey suggested a lifetime prevalence of 1.6%. 1 The Epidemiologic Catchment Area (ECA) surveys have suggested a lifetime prevalence of 1.3%. 2 An epidemiologic study of 38 000 community-dwelling individuals in 10 countries found [ajmc.com]
Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord. 2003;73:133-146. 5. Judd LJ, Akiskal HS. [mdedge.com]
Epidemiology The average lifetime prevalence rate for Bipolar II Disorder is approximately 0.5 percent. The average age for children with bipolar 2 disorder is 10 which is found in 0.3%-0.5% of patients. [courses.lumenlearning.com]
Epidemiology of bipolar disorder. In: Kasper S, Hirschfeld RMA, editors. Handbook of Bipolar Disorder. New York: Taylor and Francis; 2005. p. 21-35. 5 Coryell W. Bipolar II disorder: a progress report. [bmj.com]
Pathophysiology
[…] disorder is more common in women, whereas bipolar I affects men and women equally. 3 The age of onset of bipolar II is generally between 15 and 30 years of age, with less common new diagnoses made in childhood and in adults over the age of 65 years. 3 Pathophysiology [uspharmacist.com]
Increased chronicity and recurrent depressive phases 7, reverse vegetative symptoms, mood reactivity, as well as antidepressant non-response in bipolar II depression, on the other hand, suggest a different pathophysiological substrate than UD 11. [nature.com]
Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction may be relevant to the pathophysiology and clinical course of bipolar affective disorder 62 Chakrabarti S. Thyroid functions and bipolar affective disorder. [tandfonline.com]
Pathological amygdala activation during working memory performance: evidence for a pathophysiological trait marker in bipolar affective disorder. Hum. [frontiersin.org]
Prevention
People with bipolar II disorder can benefit from preventive drugs that level out moods over the long term. These prevent the negative consequences of hypomania, and also help to prevent episodes of depression. [webmd.com]
Examples include: Anxiety disorders Eating disorders Attention-deficit/hyperactivity disorder (ADHD) Alcohol or drug problems Physical health problems, such as heart disease, thyroid problems, headaches or obesity Prevention There's no sure way to prevent [mayoclinic.org]
Patients who recover from MDE are then randomized to receive a relapse-prevention treatment of fluoxetine, lithium, a combination of fluoxetine and lithium, or placebo for 1 year. [clinicaltrials.gov]
Prevention Bipolar II disorder cannot be prevented. Seeking treatment at the earliest sign can help prevent the condition from getting worse or interfering with your life. [baptisthealth.com]
Although preventive treatment hasn’t been identified yet, there is some hope among researchers that early treatment for cyclothymia may prevent full-blown bipolar disorder from developing. [everydayhealth.com]