[4] Bipolar Disorder Flashcards
What is bipolar disorder?
A chronic episodic mood disorder, characterised by at least one episode of mania (or hypomania), and a further episode of mania or depression.
What occurs first in bipolar disorder, depression or mania?
Can be either
What might mania be accompanied by in bipolar disorder?
Psychosis
What does the cause of bipolar disorder involve?
Biological and environmental factors
How can the monoamine theory of depression be applied to elevated mood?
It states that elevated mood is a result of increased central monoamines (noradrenaline and serotonin)
What hormonal pathways may be dysfunctional in bipolar disorder?
The HPA and HPT axis
What is the lifetime (happy now elliot????) - no you didn’t change the answer card -heritability of bipolar disorder?
Strong heritability, with the lifestyle risk of developing bipolar disorder when you have a first degree relative with the condition being 5-10%
What might precipitate the onset of the first manic episode?
Stressful and significant life events
What are the symptoms of mania?
- Irritability
- Disinhibition
- Impaired insight
- Increased libido
- Grandiose delusions
- Flight of ideas
- Appetite increased
- Sleep decreased
- Pressure of speech
- Elevated mood
- Energy increase
- Reduced concentration
What is hypomania?
Hypomania is slightly elevated mood or irritable mood, present for 4 or more days.
Symptoms of mania are present, but too a lesser extent.
How much does hypomania interfere with life?
There is considerable interference with work and social life, but not severe disruption
Do people with hypomania have insight?
Partial insight may be maintained
What is mania?
As with hypomania, but to a greater extent. Symptoms are present for at least 1 week, with complete disruption of work and social activities
How might mania cause significant disruption to life?
- May have grandiose ideas and excessive spending, which can lead to debts
- May be sexual disinhibition
- Reduced sleep may need to exhaustion
What is mania with psychosis?
A severely elevated or suspicious mood, with the addition of psychotic features such as grandiose delusions and auditory hallucinations that are mood congruent. Patients may show signs of aggression
What is the ICD-10 diagnostic criteria of bipolar?
Mania requires at least 3-9 symptoms to be present;
- Grandiosity/inflated self esteem
- Decreased sleep
- Pressure of speech
- Flight of ideas
- Distractibility
- Psychomotor agitation
- Reckless behaviour
- Loss of social inhibitions
- Marked sexual energy
Bipolar disorder requires at least two episodes in which a person’s mood and activity levels are significantly disturbed, one of which must be mania or hypomania.
What states does the ICD-10 divide bipolar disorder?
- Currently hyopmanic
- Currently manic
- Currently depressed
- Mixed disorder
- Remission
What investigations are done into bipolar disorder?
- History
- MSE
- Self-rating scales
- Blood tests to rule out oraganic causes
- Urine drug test
- CT head
What are the differential diagnoses of bipolar disorder?
- Psychotic conditions such as schizophrenia
- Medical conditions such as hyper/hypothyroidism, Cushing’s disease, cerebral tumour, or stroke
- Drug related - illicit drug ingestion, acute drug withdrawal, side effects of corticosteroid use
- Personality disorders, particularly histrionic or emotionally unstable
How is bipolar disorder managed?
- Full risk assessment, including suicidal ideation and risk to self
- Consider need for hospitalisation under the Mental Health Act
- Pharmacological management
- High-intensity psychological intervention, e.g. CBT
- ECT
Why do you need to ask about driving in bipolar patients?
DVLA has guidelines about driving when manic, hypomanic, or severely depressed
What are the indications for hospitalisation under the Mental Health Act in bipolar disorder?
- Reckless behaviour causing risk to the patient or others
- Significant psychotic symptoms
- Impaired judgement
- Psychomotor agitation
