Bipolar Flashcards
What are the symptoms of hypomania?
Present for 4 days Mild elevation or instability of mood Increased energy Mild overspending, risk-taking Increased sociability, overfamiliarity Distractibility Increased sexual energy Decreased need for sleep
What are the symptoms of mania?
Present for a week or be severe enough to necessitate inpatient admission Mood is elevated, expansive, irritable Increased activity Reckless behaviour Disinhibition Marked distractibility Markedly increased sexual energy Sleep severely impaired or absent Grandiosity Flight of ideas
What are the symptoms of mania and psychotic symptoms?
Often mood congruent
e.g. Inflated self-esteem and ideation can develop into fully-formed grandiose beliefs
e.g. Irritability and suspiciousness can develop into delusions of persecution
Hallucinations occur less frequently
How is bipolar diagnosed?
Need to elicit current symptoms and past episodes
Absolute numbers of symptoms are relatively unimportant
One episode of mania = Acute mania
Two episodes of mania = Bipolar affective disorder
One episode of mania, one episode of depression = Bipolar affective disorder
Two episodes of depression = Recurrent depressive disorder
What is Dysthymia?
Refers to the mood that is chronically low, where no episode justifies a diagnosis of a depressive disorder.
What is cyclothymia?
Persistent instability of mood with a number of periods of mild depressive symptoms or mild elation, where no episode meets the threshold for a depressive or a manic episode.
What is the epidemiology of bipolar?
Lifetime risk - 1%
Equal prevalence in men and women
Onset generally late teenage to early twenties
What is the aetiology of bipolar?
Genetics:
increased risk of bipolar disorder, unipolar depression and schizoaffective disorder
65% in identical twins, 10% risk in first degree relatives
Life events:
prolonged stressful circumstances or vulnerability factors can predispose to or preciptate episodes of affective disturbance
Substance misuse
What is the prognosis for bipolar?
The average length of a manic episode, whether treated or untreated, is 6 months
Following a manic episode, at least 90% will have a further episode of mood disturbance
Patients with bipolar disorder experience, on average, 10 episodes of mood disturbance, over a 25-year follow-up period
Recovery from acute episodes tends to be good, but the long term prognosis can be poor. Less than 20% achieve a period of 5 years of clinical stability, with good social/occupational performance
People with bipolar disorder are around 20-30 times more likely to die by suicide than are the general population
Why can relapse occur in bipolar?
Non-concordance with medication Life events, social stressors Disruption of circadian rhythm Substance misuse Childbirth (puerperal psychosis) Natural course of the illness
What is used for the management of acute mania?
Antipsychotic (haloperidol, olanzapine, risperidoen, quetiapine) Lithium or valprorate Consider benzodiazepines Stop antidepressants Low stimulus environment
What is the management for bipolar depression?
2nd line antipsychotic (olanzapine, quetiapine)
Antidepressant (needs to be used with anti-manic agent)
Mood stabiliser (lithium, valproate, lamotrigine)
CBT
What testing needs to be done when a patient is taking lithium?
Levels weekly whilst initiating and after any dose change and every 3 months thereafter; also need to check U&E and TFT every 6 months
For which medications does contraceptive advice need to be given?
folic acid if lithium, valproate, carbamazepine are prescribed to women of childbearing age.
What are the indications for mood stabilisers?
Prophylaxis for bipolar disorder
Single manic episode associated with significant risk
Illness with significant impact on functioning
Two or more acute episodes
Treatment of an acute mania/hypomania
Generally not first line
Treatment of bipolar depression
Augmentation for antidepressants in treatment-resistant depression
