Bipolar Flashcards
What is bipolar
a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression)
What is the ICD and DSM-5 criteria for diagnosis of bipolar?
ICD:
2 + episodes of mood disturbances (depression, mania)
at least 1 episode has to be mania/hypomania
DSM-5
Bipolar 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.
What is mania, hypomania and how do they differ
symptoms have t be present for at least 7 days which may be reduced due to hospital admission.
period of abnormally, and persistently elevated or irritable mood with 3+ characteristics of mania.
such as: elevated mood: overactivity, reduced sleep, overoptimistic, agreessiveness, excitability
occupational and social functioning impairment
can have psychotic features such as grandiose delusions. Auditory hallucinations (telling them how wonderful they are but if depressed it would be the opposite- usually seen in schizophrenia
hypomania: present at least for 4 days.
differs from mania:
milder
no psychotic symptoms
not much functional imapirment
hospitalisation = mania and not hypomania
what is a mixed episode
-both manic/hypomanic and depressive sympotms within the same episode.
this should be present everyday for 1 week (DSM) and 2 weeks (ICD).
-depression + overactivity
-mania + agitated and reduced energy
fluctions between mania and depression
what is the epidemiology for bipolar and the course of illness
1.3 million people have bipolar in the UK
lifetime prevalnce is 1%-2%
-course of illness varies between indidivuals
-first episode can be mania/hypomania/depression
-can have many years between first and second episode
what are some of the risks bipolar?
increases risk of suicude attempt by 20x
increased violent risk, financail risk, sexual risk
aetiology - genetics
first degree relative - 7x more likely to develop this disorder
is parent has it - 50/50 chance of developing a psychitaric illness.
what social impacts can bipolar have?
-employment (rates of bipolar are higher in unemployed people)
-social isolation (patients can socially withdraw during depressive episodes, and reckless behaviours can impact relationships which can reduce social support, long periods in hospital can lead to brekadown of friendsips)
-act on impulses and their behaviour deviates from social expectations and norms.
what are some investigations, differential diagnosis
pshyical exmainations - exclude physical illness,
full sets of blood
For investigations its done to make sure it’s not another condition, eliminating other possible conditions and diagnosis
differential diagnosis:
mania -drugs, alcohol, head injury, thyroid dysfunction, or other psychitric disorders like schizophrenia
depression- (medication-sterioids)
nerological disease like parkinsons
what is the treatment for bipolar?
there are 3 phases to consider: depression, mania and mood stabilisation
depression: normal medication for depression but if opposed it can trigger mania, SSRIs may do more harm,
ECT- for severe depression, (delievering electrical impulses to certain areas of the brain to alleviate sympptms asscaited with depression, such as mood regulation, sleep, statiety)
mania:
-benzodiazpeine to help for sedation (it is an anxiolytic that functions as a agonist which binds to GABA a receptors increasing levels of GABA which is an inhibitory neurotransmitter).
-anti psychotics such as olanzapine (it is an anatagonist that blocks dopamine D2 receptors)
mood stabilisation:
valproate - Valproate increases the levels of GABA in the brain which is a primary inhibitory neurotransmitter in the central nervous system, which helps to calm neuronal activity.
Valproate does this by inhibiting the enzyme GABA transaminase, which breaks down GABA, thus increasing GABA availability and enhancing its calming effect on the brain.
effects. controlling seizures, stabilizing mood in bipolar disorder, and preventing migraine headache
lithium is hte first line for maintenece: It may increase serotonin availability, which can help stabilize mood, and modulate dopamine levels, which are often elevated during manic phases.
side effects: weight gain, lethargy, confusion
psychological:
CBT, family therapy and psychoeducation
what are some good and poor prognosis factors and what are some triggers of relapse
poor: non-compliance, alcohol abuse
good: compliance, later age of onset, fewer psychotic symptoms
triggers: lack of sleep, increased stress, drug use
