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PY353 > Bipolar > Flashcards

Bipolar Flashcards

1
Q

BPAD stands for

A

Bipolar Affective Disorder

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2
Q 
BPAD was previously know as:
It is characterised by:
- D
- R
- L
Patients also experience mood disturbances at
A 
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
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3
Q

Manic episodes last:
Depressive episodes last:
_______ episodes occur less frequently than ______ episodes.
Patient may return to ______ between polar swings.
Mania does not always =

A 
2 weeks - 4 months
6 months - 12 months
Manic
Depressive
Normality
Euphoria
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4
Q

BPAD is subdivided into ___ forms. These are known as:

A

2

Bipolar 1 + 2

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5
Q

Bipolar 1 is also known as

A

classic mania

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6
Q

Outline Bipolar 1:

A

Mania predominates
Usually one or more depressive episodes
Characterised by one or more manic (or mixed affective state) episodes

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7
Q

Outline Bipolar 2:

A

Depression predominates

Usually one or more major depressive episodes accompanied by at least one hypomanic episode

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8
Q

Acute mania has a relatively short

A

time course

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9
Q

In mixed affective disorder, the patients experience

A

rapid alternation or co-existence of manic + depressive symptoms

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10
Q

In rapid cycling

A

4 episodes are experienced in 12 months

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11
Q

Unipolar depression is when

A

patients experience depression only

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12
Q

In terms of gender:
Bipolar 1 affects
Bipolar 2 affects

A

males and females equally

higher in females

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13
Q

Possible pathophysiology of depressive episodes?

A
  • May be due to disruption/ dysfunction of NA and other monamine NT systems,
  • Depletion of 5-HT
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14
Q

Possible pathophysiology of manic episodes?

A
  • Hyperdopaminergic state; hence efficacy of DA antagonists

- Depletion of inhibitory GABA NT

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15
Q

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

A

subtle deficits in areas of the brain (Medulla Oblongata)

locus coeruleus

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16
Q

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

A

arousal and alertness

motivation, drive and stress response
meso-limbic

mania/ hypomania symptoms

17
Q

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

A 
mood
7/7
Euphoria
Expansive
Irritable
3
self esteem
gradiosity
activity
agitation
18
Q

With BPAD, there are feelings of reduced:

As well as marked s____/ occ_______ impairment.

A

need for sleep
ability to concentrate
social
occupational

19
Q

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

A 
Valid, reliable and sensitive.
confirm diagnosis
objectively, response to treatment
side effects
audit, research
20
Q

What are some appropriate scales for use in BPAD?

A

Montgomery Asperg Depression RS
Young Mania Rating Scale
Mood Disorder Questionnaire

21
Q

What are some causes of M+M?

A

Possible self-neglect
Accidental death
Suicide (highest in Mixed Affective Disorders subset)

22
Q

Risk of suicide is highest during _____ episodes, post discharge from patient care, and as always, with co-morbidity of s_____ misuse

A

depressive

substance

23
Q

BPAD classically follows a pattern of s_____ty followed by rel___.

A

stability

relapse

24
Q

What is the aim of treatment for BPAD?

A
  • control manic + depressive symptoms
  • minimal side effects, enhancing compliance
  • prevent relapse
25
Q

BPAD:

Stability from mood enhancement/depression treatment?

A

Prophylactic agents:
lithium
valproate
carbamazepine

26
Q

BPAD:

If mania/ hypomania, treat with anti manic:

A

lithium
antipsychotics
BDZs

27
Q

BPAD:

If depressed, treat with:

A

Antidepressants according to NICE

28
Q

Pregnant women cannot take which prophylactic agent?

A

Valporate

29
Q

Depression in BPAD is harder to treat than Unipolar Depression because:

A
  • rapid onset
  • shorter duration
  • more severe
    hypersomnia and hyperphagia more likely
30
Q

Rapid-cycling bipolar affective disorder is ____ responsive to drug treatment compared to non-rapid cycling

A

less

31
Q

Which prophylactic agent is considered to be less effective in rapid cycling

A

Lithium

32
Q

Which antipsychotics are used for treatment of mania?

A

Haloperidol
Olanzapine
Quetiapine
Risperidone

33
Q

Which is the only antidepressant that is effective for treating bipolar depression in combination with which SGA?

A

Fluoxetine

Olanzapine

34
Q

Which is the most effective long-term option for BPAD and is used as first-line treatment?

A

Lithium salts

35
Q

Who are higher risk patients on lithium?

A
  • 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

PY353 (19 decks)

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