Bipolar Flashcards
How is a major depressive episode diagnosed/what are the criteria?
At least 5 specified symptoms present during the same two week period
One of the symptoms is either depressed mood or “loss of interest or pleasure”
How is mania diagnosed/what are the criteria?
Distinct period of abnormally/persistently elevated, expansive, or irritable mood lasting at least 1 week
What additional symptoms are required for a diagnosis of mania?
Three or more of following sx have persisted (4 if mood only irritable):
Inflated self-esteem or grandiosity
Dec need for sleep
More talkative than usual/pressure to keep talking
Flight of ideas
distractibility
inc in goal-directed activity/psychomotor agitation
excessive involvement in pleasurable activity with high potential for painful consequences
What is the difference between mania and hypomania?
mania = pathologically elevated or euphoric or irritable mood >1 week
- functioning impaired
hypomania = pathologically elevated or irritable mood lasting at least 4 days
- Mood/behaviour different but functioning not impaired
What are the characteristics of bipolar I disorder?
At least one episode of mania
May have episodes of depression
What are the characteristics of bipolar II disorder?
Episodes of hypomania and depression
No manic episodes
What are the characteristics of cyclothymic disorder?
At least 2 years of both hypomanic and depressive periods w/out fulfilling criteria for an episode of mania or major depression
What are the main focus areas of treating bipolar?
Treat depression and prevent recurrence
Treat mania and prevent recurrence
What are the drug treatments for acute mania?
Antipsychotics + mood stabiliser (lithium/ sodium valproate/ carbamazepine)
Antipsychotics = use short term, stop once acute mania sx remit
Mood stabilisers = continue for 6-12 months to prevent relapse, consider after if prophylaxis is needed
How is acute hypomania treated?
Self-limiting, not emergency
Does not require acute tx, may need to adjust pt treatment and psychosocial interventions
Consider tx for specific symptoms
How is hypomanic agitation treated when deemed necessary?
benzodiazepines - short term
How is bipolar acute depression treated?
Monotherapy
Lithium (slow acting), lamotrigine, or antipsychotics (lurasidone, olanzapine, quetiapine) (dopaminergic pathways)
What combination therapies are used to treat acute bipolar depression?
SSRIs + mood stabiliser (lithium, sodium valproate, antipsychotics)
How long do antidepressants remain in therapy for bipolar depression?
Always used in combination with mood stabiliser
Withdrawn within 1-2 months of depression resolution
What is the first line most effective prophylactic treatment for mania?
Lithium - good for depression too
What are antipsychotics are used in mania prophylaxis?
Aripiprazole
Asenapine
Palperidone
Ziprasidone
risperidone (depot)
What are the second line antipsychotics used in bipolar prophylaxis?
Quietiapine - prevent both depression and mania
What are the second line mood stabilisers used in bipolar prophylaxis?
Lamotrigine - preventing depression, not good for mania
Sodium valproate - bad for childbearing age
- evidence for mania and depression
Carbamazepine - limited efficacy
What are the third line antipsychotics used in bipolar prophylaxis?
Olanzapine - effective for prevention of mania and depression
