Bipolar

Question 1

Mania

Answer 1

Elevated, irritable, expansive mood for 1 week, plus 3 or more of-
Increased energy or agitation
Grandiosity
Flight of ideas
Distractable
Reduced need for sleep
Increased libido
Disinhibited 
Neglect
Psychotic- grandiose, persecutory, press speech, violence, self neglect, catatonic, loss insight.

Question 2

Hypomania

Answer 2

3 or more symptoms for at least 4 days, no affect on function-
Mildly elevated, expansive or irritable mood.
Increased energy
Increased self esteem
Sociaibilty, talkative, familiarity
Increase sex drive
Reduced need for sleep
Lack focus

Question 3

Classification

Answer 3

• bipolar 1- 1 or more manic or mixed episodes with or w/o 1 or more depressive episodes.
• bipolar 2- 1 or more depressive episodes with at least 1 hypomanic.
• ICD10- at least 2 episodes. 1 must be hypomanic, manic or mixed. Recov usually compl btw episodes.

Question 4

Prevalence

Answer 4

0.3-1.5%
Median age onset 25
Male same as female
Suicide 20x normal
£3.5bn

Question 5

Diffs

Answer 5

Normal mood changes
Adjustment disorder
PTSD
Dementia
PD
AD
Schizo
Circadian disorder
Substance
ADHD
OCD
Physical-thyr, cushings, SLE, MS, head inj, tum, epil, HIV, neurosyph.

Question 6

Causes

Answer 6

-predisposing- genetic, childhood experience, personality.
-precipitating- life event, substance, change routine, iatrogenic, viral infec.
-perpetuating- rels eg high expressed emotion, finance, subtance, neurot and endoc.
-bio- genetic, brain or physical illness
-monoamine hypothesis- NA and 5HT changes
-psycho- childhood experience, personality, view of self and world.
-social- work, housing, rels, support, money.
?abnormal apoptosis. ?Electrophysiological kindling causing neuronal injury.

Question 7

Mx

Answer 7

-pharm-
Mood stabiliser- lithium carbonate and citrate, valproate, carbamazepine, lamotrigine.
Antipsych (haloperidol, chlopromazine)
Anxiolytic
Not antiD as no ev and risk manic switch.
ECT for manic stupor.
-psych-
Psychoeducation, CBT, IPT, family therapy if high expressed emotion.
-social-
Family, housing, finance, employment, coping strategies.
-acute mania tx- haloperidol, clonazepam. ECT if sev. SGA. Lithium first line. Valproate, carbamazepine.
-dep episode tx- SSRI then mirtazepine, venlafaxine etc. ECT. Quietapine, olanzapine. Lamotragine. T3.
-prophylaxis when in remission- lithium, carbamazepine, aripiprazole, quietapine.
-psych- educ, CBT, IPT, family therapy, support groups.

Question 8

Prognosis

Answer 8

Poor facs- sev episodes, early onset, cog deficit. Tx is more effectivce earlier in the course of illness.
80% relapse after first episode within 5-7 yr.

Question 9

Cyclothymia

Answer 9

Persistent instability of mood.
Number of periods of mild dep and mild elation.
Usually starts early and is chronic. 
Lithium.
Indiv or group psychotherapy.