bipolar Flashcards
how would you explain what bipolar disorder is
bipolar disorder is a mental health condition characterized by reccurent fluctuations in mood and behavior encompassing extreme ends of the human experiences
experience intense high where you feel energetic, euphoric and may engage in impulsive behavior, or even feel irritable
but also episodes of extreme low where you feel sad, hopeless and lose interests in activities you used to enjoy
what are the risk factors of bipolar disorder
- genetics
- hx of trauma
- physical stressors
- seasonal changes
- medications
- treatment induced
- medical conditions
what are the medical conditions that can lead to risk of bipolar
vitamins/ nutrition deficiencies
- essential AA
- fatty acids
- vitD
endocrine
- hypothyroidism (depression)
- hyperthyroidism (mania)
- pregnancy/ menstrual related
electrolyte/ metabolic abnormalities
- Ca/ Na fluctuations
- hyper/ hypoglycemia
CNS infections
- neurosyphillis
- HIV
- encephalitis
CNS disorders
- brain tumor
- head injuries
- multiple sclerosis
what are the treatments that can increase the risk of bipolar disorder
- ECT
- SSRIs due to increase NE/DA in first few days to 2w of treatment
what are the medications that can increase risk of mania
drugs of abuse
- ROH
- marijuana
drugs of withdrawal potential
- BZP
- ROH
- opiates
DA-augmenting agents
NE-augmenting agents
antidepressants
- TCA
- MAOI
- 5HT/ NE/ DA reuptake inhibitors
- 5HT antagonists
thyroid preparations
- T3
- T4
xanthines
- caffeine
- theophylline
OTC
- weight loss
- decongestants
herbal
- st john’s worst
steroids
what are the differentials for bipolar disorder
- MDD
- drug/ substance induced
- anxiety disorder
- schizoaffective disorder
- personality disorder
- attention deficit hyperactive disorder
what is the presentation and diagnostic criteria for bipolar disorder (DSM-5)
for depressive sx
- 5 or more of In SAD CAGES for >2w with functional impairment
for manic sx
- 3 or more of DIGFAST for 1w and longer with functional impairment with elevated mood
D istractability/ easily frustrated
I rresponsibility and erratic uninhibited behavior
G randiosity
F light of ideas
A ctivity level increased
S leep need decreases
T alkativeness
what are the general assessments for bipolar disorders
- HPI
- psychiatric hx
- substance use hx
- complete medical and medication hx
- family, occupational, developmental and social hx
- physical and neurological exam
- mental state exam
- labs and other investigations
what are the psychiatric rating scales for bipolar disorder
clinican-rated
for mood,
- young mania rating scale
*gold standard
for general/ functional,
- clinical global impression (CGI)
- global assessment of functioning (GAF)
for QoL
- short form 36
what are the goals of therapy for bipolar disorder
- reduce frequency, severity and duration of mood episodes
- prevent suicide
- maximise adherence to therapy
- minimise treatment related ADR
- regain psychosocial functioning
what is the non-pharmacological management for bipolar disorder
- psychoeducation (recognising early s/sx of mania and depression, charting mood changes, identifying and avoiding psychosocial/ physical stressors/ drugs/ substances that can trigger a mood episode, coping strategies, developing a crisis intervention plan, importance of compliance)
- stress reduction/ relaxation
- nutrition (regular intake of protein-rich food and drinks, essential fatty acids, and supplemental vitamins)
- exercise
- sleep hygiene (regular sleep wake cycle and good night routine)
- psychotherapy (CBT)
what is the pharmacological management of bipolar disorder
for mania
- antipsychotics (FGA haloperidol; SGA olanzapine, quetiapine, risperidone (avail as LAI), aripiprazole)
- lithium
for depression
- antipsychotics (SGA olanzapine, quetiapine)
- lithium
- LTG (blocks voltage sensitive Na+ and Ca2+ channels)
*lithium is first line for maintenance and relapse, and for suicide prevention
- VPA can be as add on therapy (normalises Na+ and Ca2+ channels, increase GABA, decrease DA turnover, may decrease PKC)
what are the side effects of lithium
acne, tremor, fatigue, weight gain, nausea, ECG changes, polyuria, hypothyroidism, diabetes insipidus, cognitive impairment
what is the moa of lithium
- normalises/ inhibits secondary messenger system, may decrease PKC
- decrease 5HT reuptake and decrease DA release
what is the monitoring parameters of lithium
- TFT
- RFT
- urinalysis
- EKG
- pregnancy test
- FBC
- electrolytes
