2 - PSY - Mania and Bipolar Flashcards
Sx of hypomania
mild elevation/instability of mood ^mood overspending, risk taking ^sociability, overfamiliarity distractibility ^libido decreased need for sleep
Sx of mania
^mood, expansive, irritable ^activity recklessness disinhibition ^distractibility ^^libido sleep impaired/absent grandiosity flight of ideas
Mania with psychotic Sx - whats added
delusions - often mood congruent - eg inflated self esteem –> grandiose beliefs
hallucinations occur less frequently
Diagnosing bipolar --- 1 manic episode = 2 manic episodes = 1 mania + 1 depressive episode = 2 episodes depression =
- acute mania
- bipolar affective disorder
- bipolar affective disorder
- recurrent depressive disorder
define dysthymia
chronically low mood, no episode justifies a diagnosis of depression
define cyclothymia
persistent instability of mood - no elevation/low period reaches threshold for diagnosis of mania/depression
define double depression
episode of depression in someone with a dysthymia history
organic differentials in bipolar affective disorder
substance misuse (incl steroids) hyperthyroid (v severe) SOL (frontal lobe) metabolic disorders epilepsy
BAD epidemiology
lifetime risk, M:F, onset?
lifetime risk is 1%
male = female
onset generally late teenage to early twenties
aetiology of BAD
genetics, life events, substance misuse
what can cause a relapse???
not taking meds life events, social stressors circadian rhythm disrupted substances childbirth natural course of illness
Biological Tx of acute mania
consider benzos for disturbance
offer AP
stop any antidepressants
consider lithium/valproate
Social Tx of acute mania
maintain carer relationships ?inpatient admission calming, low stimulus environment advise not to make serious decisions whilst unwell consider use of MHA
Bio Tx of bipolar depression
antidepressant WITH anti-manic agent
consider mood stabiliser/optimise dose
consider 2nd gen/atypical AP
Psych Tx of bipolar depression
CBT if mild/mod episode
psychoeducation
