Bipolar Flashcards
Bipolar
a dramatic shift in emotion in mood and energy
extreme highs and lows (same as unipolar depresion)
highs: energetic, overly happy, euphoric, high self esteem (not necessarily happy but a high mood)
management: lithium therapy (Used in bipolar. Mood stabiliser. Narrow therapeutic index (0.4-1.0)
cyclothemia
milder highs and milder lows, cycles >2 years
bipolar management
if mania episode whilst on antidepressent then stop the antidepressent
antipscyhotic- olanzopine
lithium is contraindicated in pregnnacy!
types of bipolar
formally known as manic depression.
3 types
1. bipolar 1 disorder= an underlying depression, interspersed with episodes of mania (1:1)
- bipolar 2 disorder= depression is more predominant. the ratio of depressive to manic episodes 5:1. manic episodes are slight (sub mania) or precipitated by antidepressant medication
- rapid cycling bipolar. >4 episodes/year of mania and depression
- cyclothymia (rapid mood changes)
- hyperthymia (unusual periods of elated feelings)
factors that can precipitate a bipolar event
life factors which lead to early morning waking (shift patterns) positive life events negative life events pregnancy CVA (frontal lobe) steroids stimulants thyroid disease antidepressants, alcohol, cannabis.
what are the clinical features of bipolar?
elated mood:
- mania- elated mood lasting 1-2 weeks with psychotic symptoms. affects social functioning
- hypomania: no psychotic symptoms, last >4 days.
irritable mood:
- can occur between periods of elevation. inappropriate anger. labile mood
feelings of increased fuel worth inappropriate social behaviour compulsive actions- gambling, spending money, dangerous driving lack of sleep tighten sense of ones abiliy/presitge delusions hallucination auditory hallucinations very fast speech altered perceptions
DSM-V criteria for bipolar
Elated or irritable mood for at least one week, PLUS at least three of:
Inflated self esteem
Decreased need for sleep
Accelerated speech
Racing thoughts / flight of ideas
Distractibility (reported or observed)
Increased goal directed activity or psychomotor agitations
Excessive activity
Impaired social or occupational functioning
Episode not due to substance misuse or other organic cause
investigations for bipolar
rule out an organic cause
FBC
UEC
LFTs
TSH
Urinary drug screen
Neurochemistry, Neuroimaging and Neuropathology
PET scan – excessive post synaptic dopamine 2 activity in mania
Increased serotonin and noradrenaline levels – during episodes of mania – but the evidence is not conclusive
Inositol phosphate – a chemical that increases the metabolism of lithium is increased in mania
Cortisol – in mania, there is increase cortisol release/response to stress
White-matter hyper-intesities- the presence of these is related to poor prognosis, increased frequency of manic episodes, and cognitive impairment
management of bipolar
for acute manic episode:
1st line: atypical antipsychotic (olanzapine, risperidone, clozapine)
2nd line: valproate, lamotrigine (anticonvulsant) lithium
for depressive episode
avoid antidepressants as this can cause a rapid cycling mood
- atypical antipsychotic (olanzapine) and add anticonvulsant or lithium
general maintenance of bipolar
mood diary
lithium (mood stabiliser)
psychological: CBT
mania
elevation of mood, increased energy, ideas of self importance
rapid or forced speech
flight of ideas
express grandiose ideas
mx: lithium hypothyroidism, hypokalaemia, chronic renal impairment nephrogenic diabetes insipidus confusions coma tremor vomiting diarrhoea
heroin withdrawal signs
neuro- agitation, paraesthesia, dilated pupils
psychological- depression, craving
GI- diarrhoea, vomiting, abdominal cramps
derm- sweating, goose bumps
