Bipolar Disorder

Perinatal Bipolar Disorder

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Bipolar Disorder Tip Sheet

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Bipolar Disorder Slide Deck

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Key Considerations for Perinatal Bipolar Disorder:

  • Pregnancy and the postpartum period pose increased risks for symptom exacerbation and new diagnosis.
  • Untreated bipolar disorder in pregnancy can lead to preterm birth, low birth weight, and developmental issues.
  • Postpartum period carries a high risk of relapse and postpartum psychosis.

Bipolar Disorder Types:

  • Bipolar I: At least one manic episode lasting >1 week causing marked impairment.
  • Bipolar II: Hypomanic episode (>4 days) plus a depressive episode without marked impairment.

Common Symptoms of Mania/Hypomania:

  • Distractibility
  • Impulsivity/Indiscretion
  • Grandiosity
  • Flight of ideas
  • Increased goal-directed activity
  • Decreased need for sleep
  • Talkativeness/pressured speech

Risk Factors for Perinatal Relapse:

  • History of rapid cycling or mixed episodes
  • Younger age at onset
  • Frequent past episodes (>1 per year)
  • Abrupt discontinuation of mood stabilizers
  • Unplanned pregnancy
  • Previous psychiatric hospitalizations

Screening and Assessment:

  • Utilize the Mood Disorder Questionnaire (MDQ) for initial screening.
  • Conduct thorough clinical interviews to assess risk factors and symptom history.
  • Refer all suspected cases to psychiatry for further evaluation and treatment planning.

Management Strategies for Care Managers:

  1. Medication Adherence:
    • Reinforce the importance of continuing prescribed mood stabilizers.
    • Collaborate with the obstetric team for safe medication management.
  2. Monitoring and Psychoeducation:
    • Provide education on early warning signs of mood episodes.
    • Conduct frequent symptom checks, especially 1-2 weeks postpartum.
    • Educate family (with consent) on risks and signs of postpartum psychosis.
  3. Lifestyle Recommendations:
    • Encourage regular sleep patterns (goal: 5 hours uninterrupted).
    • Promote social support and engagement in psychotherapy.
    • Advocate for a healthy diet and avoidance of substances (alcohol, caffeine, cannabis).
  4. Emergency Preparedness:
    • Educate on postpartum psychosis symptoms (e.g., mood lability, delusions, confusion).
    • Ensure immediate referral for psychiatric inpatient care if psychosis is suspected.

Postpartum Considerations:

  • Women with bipolar disorder are 23x more likely to require psychiatric hospitalization postpartum.
  • Risk of postpartum depression is significantly higher.
  • Ensure close follow-up within the first 2 weeks postpartum to monitor mood stability.

Resources for Further Support:

  • National mental health organizations specializing in perinatal mood disorders.
  • Support groups for individuals with perinatal bipolar disorder.
  • Online resources for patient and family education