Bipolar Flashcards
What is ICD-10 definition of bipolar?
- 2 + episodes of mood disturbances (depression, mania)
- At least 1 episode has to have been mania/hypomania
What are the two DSM 5 definition for bipolar?
-Bipolar 1 – 1 episode of mania
(may be followed by episode of
depression/hypomania)
-Bipolar 2 - at least one hypomanic episode and at least one major depressive episode
Describe mania
- Symptoms must be present for at least 7 days or less if admission to hospital
- Period of abnormally & persistently elevated, expansive or irritable mood with 3+ characteristic symptoms of mania
- The disturbance must cause impairment to occupational or social function.
- Can have psychotic features
What are symptoms of bipolar?
- elevated mood
- increased energy
- increased self esteem
- psychotic symptoms
- easily distracted
- risky behaviour
- behavioural manifestations
- Disruption to work/family/social life
What are psychotic symptoms of mania?
- Grandiose delusions
- Suspiciousness – can turn into persecutory delusions
- Pressured speech so severe unable to understand
- Irritable behaviour -> violent behaviour
- Catatonic behaviour
- Complete loss of insight
Describe criteria for hypomania
-Symptoms must be present for at least 4 days
-Similar to mania symptoms
But milder
No psychotic symptoms
Functioning not markedly impaired
- If requires hospital admission -> Mania
- If only hypomania: Bipolar Type II
What is criteria for depression?
- Five (or more) of the following symptoms have been present during the same 2-week period
- at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure
- low mood
- weight loss
- insomnia
- fatigue
- loss of energy
What is definition of mixed episode
-When you have both manic/hypomanic and depressive symptoms in a single episode, present everyday for at least 1 week (DSM) or 2 weeks (ICD)
What are typical presentations of mixed episode?
- Depression + overactivity/pressured speech
- Mania + agitation and reduced energy
- Low mood + other manic symptoms
- Fluctuation between mania and depression
What is epidemiology for bipolar?
- 1.3 million people in the UK have bipolar
- prevalence is 1% to 2%
- M:F = 1:1
- Onset usually late adolescence/early adulthood but can occur at any age
- Bipolar increases an individual’s risk of suicide by up to 20 times
How likely are you to develop bipolar disorder if your first degree relative had it?
-7x more likely (5-10%)
What are chances of developing psychiatric illness if parent had bipolar?
-50%
Describe course of illness for bipolar
- Variable by person
- First episode can be hypomania, mania or depression
- Can have many years between first episode and second
- Often 5-10 year interval between onset of illness and getting help
- Manic episodes shorter than depressive if untreated (6 vs. 11 weeks)
- Rapid cycling (>4/yr)
- Gap between episodes shortens with progression
- Pregnancy (>50% chance of relapse)
What 3 social factors affect BD?
- Employment
- Social isolation
- The family
What is relationship between bipolar and employment?
-Rates of positive screening for bipolar disorder are higher in unemployed people, in those receiving particular benefits, and in people living alone.
How can isolation contribute to bipolar disorder?
- Patients may become socially withdrawn during depressive episodes
- Reckless behavior may impact on relationships leading to reduced social support
- Long periods in hospital may lead to breakdown of friendships
How can family issues affectBD?
- Financial distress
- Strained relationships, increased divorce rates
- Social isolation
- Development of mental health difficulties in other members of the family
What investigations are done to diagnose BD?
- Physical examination – exclude physical illness first
- Full set bloods
What are the other differential diagnosis for bipolar?
- Mania
- Depression
What are the three phases of BD to consider when doing treatment?
- BPAD Depression
- Acute mania
- Mood stabilisation
What is treatment options for bipolar depression?
- If severely depressed/suicidal/urgent can use ECT
- Lithium
- Valproate
- Anti-psychotic eg quetiapine
- Anti-convulsant eg lamotrigine
- SSRIs - fluoxetine and olanzapine
- psychological therapy
What is treatment options for acute mania?
- Lithium – response rate of around 80% but takes up to 2 weeks to take effect.
- Valproate
- Antipsychotic – good in acute behavioural disturbance eg olanzapine, quetiapine, risperidone, haloperidol
- BDZ – used to help with sedation whilst waiting for above to work
- ECT (catatonia/prolonged or severe manic episode) – good evidence, seldom used. Pregnancy and breastfeeding
What is the purpose of maintenance?
-Prevention of recurrent episodes
What is the first line of maintenance treatment?
-Lithium
What are psychological treatments for bipolar?
- CBT
- Family therapy
- Psychoeducation
- Support Groups
What is meant by renal therapeutic index for lithium?
- Narrow
- there is only a small difference between the minimum effective concentrations and the minimum toxic concentrations in the blood
How is lithium removed from the body?
-Exclusive renal excretion
What are side effects for lithium?
- weight gain, fine tremor, lethargy and skin problems
What is meant by lithium toxicity?
- lithium overdose
- coarse tremor
- dehydration
- confusion
- drowsiness
What are poor prognostic factors for bipolar?
- poor employment
- alcohol abuse
- depression
- male
- psychotic features
What are good prognostic factors for bipolar?
- later onset
- short episodes of mania
- fewer sucidal thoughts
- good treatment response
- fewer psychotic symptoms
What are triggers of relapse in BD?
- non-concordance
- illicit drug use
- lack of sleep
- increased stress (bereavement and exams)
What are risks for having BPAD?
- Suicide
- unintentional self injury
- financial risk
- sexual risk
- violent risk
- arson
