Bipolar Flashcards
What is bipolar affective disorder?
Condition characterised by a diagnosis of an episode of depression lasting at least 2 weeks followed by a period of normal mood and an episode mania for at least 1 weeks or requiring hospitalisation, which is generally divided into bipolar I and bipolar II. The period between episodes stabilise between the 4th and 5th episode, and there is often a 5 year interval between onset, typically around 21 years old and first treatment.
Depression within bipolar coincides with the presentation of major depressive disorder.
What are the clinical features of mania?
Mania must occur for at least 1 week or be severe enough to require hospitalisation and is characterised by:
->Thought disorders and pressured speech
-> Increased impulsivity and risk taking behaviours like gambling
-> High libido and substance use
-> Reduced need for sleep
-> Elevated mood
Sevre mania can be associated with psychotic symptoms such as grandiose ideas, persecutors delusions and flight of ideas. They may have partial or total loss of insight and in extreme cases go into a manic stupor.
What is the management for mania?
Risk assessment for Mania is essential to ensure patient safety
->It is important to exclude other potential causes such as other psychotic disorders, ADHD, ->substance abuse or physical illness
->Address psychosocial stressors
->Pharmacological treatment and ECT
What is Bipolar I disorder?
Patient experiences:
Criteria for major depressive disorder for at least 2 weeks
Mania for at least 1 week or requiring severe hospitalisation
What is Bipolar II disorder?
Patient experiences:
Criteria for major depressive disorder for at least 2 weeks
Hypomania for at least 4 days
What is cyclothymia?
Patient experiences periods of hypomania and depressive symptoms which do not fulfil the criteria for major depressive disorder and are unrelated to life events, present for at least 2 years and each episode lasting less than 2 months.
This typically occurs in early adulthood, with links to a family member diagnosed with bipolar.
Cyclothymia can be managed with:
-> mood stabiliser like lithium
->Antipsychotic at a low dose during hypomania
->Psychotherapy and psychoeducation to enable better coping mechanisms
How is an acute manic episode treated?
Assess recent treatment changes in patient and compliance
First line treatment is antipsychotic, alongside benzodiazpines which reduce the dose required to achieve sufficient sedation
—> olanzapine, rsperidone and quetiapine are first line
Lithium has delayed effect for severe mania and may take up to 3 weeks for maximal effectiveness
ECT if treatment options have failed
What is the epidemiology of bipolar disorder?
Greater prevalence of bipolar I
Men tend to experience more mania; women tend to experience more depressive symptoms
Peaks in onset at 15-19 and 20-24 years old, with a mean of 21 years old
How is bipolar depression treated?
Depression in bipolar occurs more frequently and is more disruptive, with a greater suicide risk and a lower responsiveness to antidepressants compared to unipolar depression.
What is the management for bipolar affective disorder?
Generally, management is focused on prevention of recurrent episodes and reducing suicide risk
-> Lowest medication dose, aiming for a single agent or if not mood stabiliser with antipsychotic OR antidepressant
-> Use of lithium for maintenance
-> Following remission from an episode, provide therapeutic dose of mood stabiliser and gradually withdrawal antipsychotic or benzodiazepine, with monitoring of side effects
Psychoeducation is essential because it gives patients an understanding of their illness to improve medication adherence and improving their insight to recognise episodes.
CBT is useful for teaching skills to cope with psychosocial stressors
Support groups
Family focused therapies to accept the reality of the illness and planning strategies for minimising stressors on the patient
