Page 15 - e-book CPG - Bipolar Disorder

CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)

1. INTRODUCTION

Bipolar disorder (BD) is a potentially life-long disabling condition presenting commonly as
either bipolar I disorder (BD I) or bipolar II disorder (BD II). BD I is characterised by episodes
of mania (abnormally elevated mood or irritability and related symptoms with severe functional
impairment or psychotic symptoms for seven days or more). On the other hand, BD II is
characterised by episodes of hypomania (abnormally elevated mood or irritability and related
symptoms with decreased or increased function for four days or more) and depressive
episodes.

BD is a severe mental disorder. Based on World Health Organisation (WHO) statistics in 2019,
its global prevalence was estimated to be around 40 million. In the Global Burden of Disease
1
Study 2019, the prevalence of BD showed an increasing trend from 24.8 million in 1990 to
2
39.5 million in 2019. Its prevalence in Malaysia, however, is not well-established. BD is
associated with reduced functioning, cognitive impairment and decreased quality of life (QoL).
It is also one of the leading causes of disability in young people and increased mortality,
especially by suicide. 3

Diagnosis of BD may be difficult given the complexity of its clinical presentation which may
overlap with other psychiatric disorders and change over time. Moreover, managing BD is
limited by the lack of resources including expertise and medications. Poor adherence remains
a major issue that needs to be tackled in its management.

The first edition of the CPG Management of BD in Adults was published in 2014. Since then,
there have been advances in the management of BD which include wider medication choices
and new treatment modalities that incorporate technological advancement.

This revised edition provides updates on the evidence and related recommendations on the
current management of BD, keeping in mind the acceptability of the treatment and availability
of resources. It also addresses the management of children and adolescents, and looks into
evidence on psychospirituality as well as complementary and alternative medicine. Previous
topics on psychosocial interventions, suicide prevention and management in pregnant and
lactating women are further expanded.

This CPG is aimed to be used at primary, secondary, and tertiary health care settings. It is
also useful for those involved in psychiatric training. It is hoped that this CPG will be of benefit
to healthcare professionals and help improve the management of patients with BD.

2. RISK FACTORS

Identifying risk factors of BD may assist in the early detection of BD.

Several factors increase the risk of people developing BD which include:
 offspring of maternal age group ≥40 years old (OR=1.20, 95% CI 1.10 to 1.31). 4, level II-2
 presence of major depression with attention-deficit hyperactivity disorder (ADHD)
(OR=1.50, 95% CI 1.30 to 1.72). 5, level II-2

Apart from the above, the established risk factors for BD are:
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 family history of BD
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 young age (<25 years old)
 low educational level
6
 low employment level 6

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