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Psychiatric Medicine > Affective disorders - Bipolar disorder and Mania > Flashcards

Affective disorders - Bipolar disorder and Mania Flashcards

1
Q

What is mania?

A

https://www.youtube.com/watch?v=zA-fqvC02oM

Mental illness marked by periods of great excitement or euphoria, delusions, and overactivity. Rarely a symptom, often associated with grandiose ideas, disinhibition, loss of judgment; with similarities to the mental effects of stimulant drugs (AMPH, cocaine)

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2
Q

How long must manic symptoms be present before a diagnosis of mania is made?

A

> 1 week

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3
Q

What is hypomania?

A

Hypomania has many of the same symptoms as mania, but without psychosis, impairment of daily functioning, or need for inpatient treatment

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4
Q

What are the psychotic symptoms of mania?

A
  • Flight of ideas
  • Delusions of grandure
  • 2 person auditory hallucinations
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5
Q

What are the signs of mania with regard to mood?

A
  • Irritability
  • Euphoria
  • Lability
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6
Q

What are behavioural signs of Mania?

A
  • Hyperactive/increased energy/irritable
  • Decreased need for sleep
  • Hypersexual
  • Extravagance/overspending
  • Over-familiar
  • Recklessness
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7
Q

What signs in terms of appearence might you see in someone with mania?

A
  • Extravagant clothing
  • Bizarrely dressed
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8
Q

In terms of speech, what might you observe in someone who is manic?

A
  • Pressure of speech
  • Increased rate
  • Prolonged
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9
Q

In terms of thought form, what might you observe in a manic individual?

A
  • Flight of ideas
  • Racing thoughts
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10
Q

In terms of thought content, what might be observed in mania?

A
  • Delusions of grandure
  • Inflated self-esteem
  • Persecutory delusions
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11
Q

In terms of perception, what might you observe in someone with mania?

A
  • 2nd person auditory hallucinations
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12
Q

In terms of cognition, what might you see in mania?

A
  • Grandiosity
  • Distractibility/poor concentration
  • Confusion
  • Lack of insight
  • Disinhibition
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13
Q

In terms of insight, what might you see in someone with mania?

A

Total lack of insight

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14
Q

In terms of risk, what might you find in someone with mania?

A

May be a risk to themselves or others due to reckless or deluded behaviours

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15
Q

What is the differential diagnosis for someone who presents with manic symptoms?

A
  • Schizophrenia, schizoaffective, delusionsal disorder
  • Cyclothymia
  • Drugs/Alcohol
  • ADHD/conduct disorder
  • Endocrine - Cushing’s, hyperthyroidism
  • SLE
  • Stroke, MS, Tumour, epilepsy
  • AIDS, neurosyphilis
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16
Q

What endocrine problems can cause manic symptoms?

A
  • Cushing’s
  • Hyperthyroidism
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17
Q

What neurological disorders can cause manic symptoms?

A
  • Stroke
  • MS
  • Tumour
  • Epilepsy
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18
Q

What infections can cause manic symptoms?

A
  • AIDS
  • Neurosyphilis
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19
Q

What systemic illness can cause manic symptoms?

A

SLE

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20
Q

What medications can cause manic symptoms?

A
  • Steroids
  • Antidepressants
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21
Q

What illicit substances can cause mania?

A
  • Cocaine
  • Amphetamines
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22
Q

How would you assess someone with manic symptoms?

A
  • MSE
  • Assessment tools
  • Exclude other causes
    • Bloods
    • Infection screen
    • CT/MRI
    • ECG
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23
Q

What routine blood tests would you to investigate treatable causes of mania in a patient?

A
  • FBC
  • U+E’s
  • LFTS
  • TFTs
  • ESR
  • Glucose
  • Calcium
  • Tox screen
  • ANA
  • HIV test
24
Q

How would you treat someone with mania?

A

May need to be sectioned under mental health act

  • Benzodiazepines/sedation
  • Antipsychotics
  • Consider stopping antidepressants
  • Mood stabilisers
25
Q

What are the commonly used mood stabilisers?

A
  • Lithium
  • Anticonvulsants
    • Valproic acid
    • Carbemazepine
    • Lamotrigine
26
Q

What is the mechanism of action of lithium?

A

The mechanism of action of lithium is unknown. It may include alterations in transmembrane ion flux and / or reduction in phosphatidylinositide turnover, which lead to mood stabilization.

27
Q

What are the indications for use of lithium?

A
  • Treatment and prophylaxis of mania
  • Bipolar disorder
  • Recurrent depression
  • Aggressive or self-mutilating behaviour (rarely used)
28
Q

What are the side effects of lithium?

A
  • Gastro intestinal disturbance
  • Fine tremor
  • ADH antagonism + tubulointerstitial damage -> nephrogenic diabetes insipidus
  • Weight gain and oedema
  • Exacerbation of psoriasis
  • Goitre and thyroid dysfunction
  • Reduced seizure threshold
  • Toxicity
29
Q

What are signs of lithium intoxication?

A
  • Vomiting, diarrhea
  • Ataxia
  • Dizziness
  • Slurred speech
  • Nystagmus
30
Q

What signs/symptoms would indicate severe lithium toxicity?

A
  • Hyper-reflexia
  • Convulsions
  • Psychosis
  • Syncope
  • Renal insufficiency
31
Q

What is the blood level that is aimed for when using lithium?

A

0.6-1.2mmol/L

32
Q

When considering starting lithium, what should you do first?

A
  • Baseline U+E and TSH
  • Pregnancy test in woman
33
Q

How long does it take for lithium to reach a steady state after first dose?

A

5 days

34
Q

How often should lithium levels be checked once steady state is established?

A

3 months

35
Q

When should you recheck U+E’s, creatinine and TSH in somoene on lithium?

A

6 months

36
Q

What is the mechanism of action of sodium valproate/valproic acid?

A

Three separate methods:

  • Increasing the amount of GABA in the brain
  • Blocking Sodium Channels
  • Blocking Calcium Channels

It increases the amount of GABA in the brain by inhibiting the enzyme GABA Transaminase, which normally breaks down GABA.

By blocking both sodium and calcium channels, Valproate prevents the depolarisation/firing of neurones

37
Q

What are the side effects of sodium valproate/valrpoic acid?

A
  • SEVERE - sudden onset of liver failure, acute pancreatitis and severe thrombocytopenia.
  • Nausea and vomiting
  • Diarrhoea
  • Weight gain
  • Oedema
  • Hallucinations
38
Q

When giving sodium valproate/valproic acid, what baseline tests should you do?

A
  • LFTs
  • Pregnancy test
  • FBC
39
Q

When is carbemazepine indicated for use?

A
  • Acute mania
  • Mania prophylaxis
40
Q

What is the first line treatment for acute mania and mania prophylaxis?

A

Carbemazepine

41
Q

What is the mechanism of action of carbemazepine?

A

Carbamazepine acts by binding to the sodium channels of neuronal membranes and prevents the influx of sodium into the cell which normally leads to an action potential. By preventing depolarisation of these neurones, there is not the repeated “firing” of action potentials that is responsible for epileptic seizures.

42
Q

What are the side effects of carbemazepine use?

A
  • Skin conditions
  • SIADH
  • Nausea and vomiting
  • Dry mouth
  • Peripheral Oedema, weight gain
  • Dizziness
  • Drowsiness and fatigue
  • Headache
  • Abnormal LFTs
  • AV conduction delays
43
Q

What serious skin conditions can occur with the use of carbemazepine and lamotrigine?

A
  • SJS
  • Toxic Epidermal Necrolysis
44
Q

What baseline measurements should you take before starting someone on carbemazepine?

A
  • FBC
  • LFTs
  • ECG
45
Q

What is the mechanism of action of lamotrigine?

A

Acts as a sodium channel blocker, to reduce the influx of sodium ions into neurones, and therefore reduced action potentials. This effectively stops the neurones from repetitively “firing” and therefore prevents seizures.

46
Q

What are the side effects of lamotrigine?

A
  • Rashes
  • Nausea, vomiting and diarrhoea
  • Somnolence or insomnia
  • Headache
  • Dizziness
  • Blurred vision or diplopia
  • Ataxia
  • Skin conditions
  • Haematological abnormalities
47
Q

What is biplar affective disorder?

A

A disorder characterised by repeated episodes of mania and depression:

  • At least two episodes of mania
  • (or) one episode of mania and one episode of depression

Characteristically, recovery is usually complete between episodes

48
Q

How would you treat a severe/life-threatening manic episode?

A

ECT

49
Q

How would you manage someone with bipolar disorder?

A
  • Mood stabilisers
  • Antipsychotics - even if not psychotic
  • Antidepressants - so long as they have not induced mania for the patient in the past!
50
Q

How would you treat someone with bipolar disorder who was having a severe/life-threatening episode of depression?

A

ECT

51
Q

What long term prophylaxis is often used to control bipolar disorder?

A

After successful treatment of manic/depressive episode + baseline is normal:

Lithium carbonate

52
Q

What are the concerns with lithium toxicity and pregnancy?

A

Developmental disorders

  • Ebsteins anomaly
  • Floppy baby syndrome
  • Thyroid abnormalities
53
Q

How long do typical manic episodes in bipolar disorder last for?

A

1-3 months

54
Q

What percentage of those with bipolar disorder die by suicide?

A

10%

55
Q

Which sex is bipolar disorder more common in?

A

Neither, both sexes are equal

56
Q

What is the mean age of onset of bipolar disorder?

A

21

Psychiatric Medicine (16 decks)

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