Bipolar - 4 Flashcards
Klerman bipolar I
Mania with depression
Klerman bipolar type II
Hypomania with depression
Klerman bipolar type III
Cyclothymic disorder /personality
Klerman bipolar type IV
Hypomania or Mania peecipitared by antidepressants
Klerman bipolar type V
Depression with a family history of bipolar
Klerman bipolar type VI
Mania without depression
Contemporary application of Klerman classification
Klerman’s classification is limited; modern psychiatry favours individualized care.
Akiskal classification 1999
Bipolar I
Bipolar I 1/2
Bipolar II
Bipolar II 1/2
Bipolar III
Bipolar III 1/2
Biplar IV
Akiska 1999 Bipolar I
Full Blown Mania
Akiska 1999 Bipolar I 1/2
Depression with protracted hypomania
Akiska 1999 Bipolar II
depression with hypomania
Akiska 1999 Bipolar II 1/2
Cyclothymic depressions
Akiska 1999 Bipolar III
antidepressant associated hyomania
Akiska 1999 Bipolar III 1/2
Bipolarity unmasked/masked by substance abuse
Akiska 1999 Bipolar IV
Hyperthymic depression
Main differences between bipolar and borderline personality disorders
-Psychomotor activation in BD
-Self destructive behaviours in BPD
-Hx of sexual trauma in BPD
-Characteristic features of BPD
-Genetic
What are psychomotor activations in BD
-Decrease need for sleep
-Higher energy
-Increased goal-directed activities
- Pressured speech
Prevalence of self-disctructive cutting behaviours in Borderline vs Bipolar
Borderline ===>50-80%
Bipolar ===> Very Uncommon
Hx of sexual trauma in Borderline PD VS bipolar
Borderline 40-70%
Bipolar 20-40%
Hx of sexual trauma in general population
13-17% females
2.5-5% in males
Borderline characteristic that rarely seen in bipolar
- Abandonment
- Identity disturbance
- Recurrent suicidal or self mutilating behaviours
- Dissociative symptoms
Heritability of bipolar
80-90%
Overal risk of postpartum biplar relapse
37%
Postpartum replace % on prophylactic bipolar vs off prophylactic bipolar
23% vs 66%
Bipolar medications that should be stoped in pregnant bipolar patients
Valproate
Lithium
Carbamazepine
Lamotrigine
What do NICE and Maudsley offer for pregnant patient with bipolar
Antipsychotics
What if a pregnant patient with bipolar is on lithium?
Stop slowly over 4 weeks to avoid relapse
Then start antipsychotics
What if
a patient with bipolar gets pregnant and cannot come off lithium?
Check the level of lithium every 4 weeks until week 36, then every week
What happens to lithium level in pregnancy
Drops
How to manage a bipolar pregnant women with mild depression
-Self help (computerised cbt)
-Brief psychological interventions
-Antidepressants
Average brief psychological intervention
5-8 sessions
Pregnant patient develops actue mania, Rx is
Antipsychotic
Moderate to severe depression in pregnant women with bipolar
CBT ====>Moderate
CBT + Medication ===> severe
