Bipolar Flashcards
BPAD stands for
Bipolar Affective Disorder
BPAD was previously know as: It is characterised by: - D - R - L Patients also experience mood disturbances at
Manic depression Diversity; variety of presentations Recurrent; Relapse/ remitting Life long; can treat but not cure opposite poles e.g. mania/ hypomania v.s depression
Manic episodes last:
Depressive episodes last:
_______ episodes occur less frequently than ______ episodes.
Patient may return to ______ between polar swings.
Mania does not always =
2 weeks - 4 months 6 months - 12 months Manic Depressive Normality Euphoria
BPAD is subdivided into ___ forms. These are known as:
2
Bipolar 1 + 2
Bipolar 1 is also known as
classic mania
Outline Bipolar 1:
Mania predominates
Usually one or more depressive episodes
Characterised by one or more manic (or mixed affective state) episodes
Outline Bipolar 2:
Depression predominates
Usually one or more major depressive episodes accompanied by at least one hypomanic episode
Acute mania has a relatively short
time course
In mixed affective disorder, the patients experience
rapid alternation or co-existence of manic + depressive symptoms
In rapid cycling
4 episodes are experienced in 12 months
Unipolar depression is when
patients experience depression only
In terms of gender:
Bipolar 1 affects
Bipolar 2 affects
males and females equally
higher in females
Possible pathophysiology of depressive episodes?
- May be due to disruption/ dysfunction of NA and other monamine NT systems,
- Depletion of 5-HT
Possible pathophysiology of manic episodes?
- Hyperdopaminergic state; hence efficacy of DA antagonists
- Depletion of inhibitory GABA NT
From post-mortem studies it is evident that patients with BPAD and unipolar depression have:
Patients with BPAD have a greater concentration of neurones in the ____ ________ than unipolar patients
subtle deficits in areas of the brain (Medulla Oblongata)
locus coeruleus
Lous coeruleus neurones are in part responsible for :
They also have a role to play in:…… via the ______ pathway
Increased LC neurones in BPAD patients may account, in part, for
arousal and alertness
motivation, drive and stress response
meso-limbic
mania/ hypomania symptoms
DSM-V criteria for Mania:
Distinct period of abnormal ____ for > _____.
E_______, E______ or I_______ with _ or more associated features present to a significant degree.
Increased s___/e_____, g_____, a___y, flight of ideas, racing thoughts, speech, psychomotor ag_____n
mood 7/7 Euphoria Expansive Irritable 3 self esteem gradiosity activity agitation
With BPAD, there are feelings of reduced:
As well as marked s____/ occ_______ impairment.
need for sleep
ability to concentrate
social
occupational
BPAD rating scales must be:
They should be used to
They should measure
Identify and evaluate _______ of medication
can also be of great value in a___, re_____ etc
Valid, reliable and sensitive. confirm diagnosis objectively, response to treatment side effects audit, research
What are some appropriate scales for use in BPAD?
Montgomery Asperg Depression RS
Young Mania Rating Scale
Mood Disorder Questionnaire
What are some causes of M+M?
Possible self-neglect
Accidental death
Suicide (highest in Mixed Affective Disorders subset)
Risk of suicide is highest during _____ episodes, post discharge from patient care, and as always, with co-morbidity of s_____ misuse
depressive
substance
BPAD classically follows a pattern of s_____ty followed by rel___.
stability
relapse
What is the aim of treatment for BPAD?
- control manic + depressive symptoms
- minimal side effects, enhancing compliance
- prevent relapse
BPAD:
Stability from mood enhancement/depression treatment?
Prophylactic agents:
lithium
valproate
carbamazepine
BPAD:
If mania/ hypomania, treat with anti manic:
lithium
antipsychotics
BDZs
BPAD:
If depressed, treat with:
Antidepressants according to NICE
Pregnant women cannot take which prophylactic agent?
Valporate
Depression in BPAD is harder to treat than Unipolar Depression because:
- rapid onset
- shorter duration
- more severe
hypersomnia and hyperphagia more likely
Rapid-cycling bipolar affective disorder is ____ responsive to drug treatment compared to non-rapid cycling
less
Which prophylactic agent is considered to be less effective in rapid cycling
Lithium
Which antipsychotics are used for treatment of mania?
Haloperidol
Olanzapine
Quetiapine
Risperidone
Which is the only antidepressant that is effective for treating bipolar depression in combination with which SGA?
Fluoxetine
Olanzapine
Which is the most effective long-term option for BPAD and is used as first-line treatment?
Lithium salts
Who are higher risk patients on lithium?
- older patients
- patients taking meds that interact
- patients with poor adherence
- patients with poor symptom control
- patients with plasma lithium level of 0.8mmol/L or more
- hypercalcaemia
- patients at risk of impaired renal or thyroid function
