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Bipolar Affective Disorder Flashcards

1
Q

What is Bipolar?

A

Part of the ‘mood/affective disorders’

Episodes of mania/hypomania and depression

Interspersed by periods of normal mood and functioning

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2
Q

Aspects of BPAD

A
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3
Q

Epidemiology - BPAD

  • Sex ?
  • Average age of onset …. years
  • 90% before … years
  • Life time prevalence: 1-3% general population
  • Lifetime competed suicide rates 10 – 15%
A
  • Sex: ♀ = ♂
  • Average age of onset 20 years
  • 90% before 30 years
  • Life time prevalence: 1-3% general population
  • Lifetime competed suicide rates 10 – 15%
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4
Q

Epidemiology - BPAD

  • Sex: ♀ = ♂
  • Average age of onset 20 years
  • ….% before 30 years
  • Life time prevalence: …-…% general population
  • Lifetime competed suicide rates 10 – 15%
A
  • Sex: ♀ = ♂
  • Average age of onset 20 years
  • 90% before 30 years
  • Life time prevalence: 1-3% general population
  • Lifetime competed suicide rates 10 – 15%
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5
Q

Epidemiology - BPAD

  • Sex?
  • Average age of onset 20 years
  • 90% before 30 years
  • Life time prevalence: 1-3% general population
  • Lifetime competed suicide rates … – ….%
A
  • Sex: ♀ = ♂
  • Average age of onset 20 years
  • 90% before 30 years
  • Life time prevalence: 1-3% general population
  • Lifetime competed suicide rates 10 – 15%
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6
Q

Epidemiology - BPAD

  • Sex: ♀ = ♂
  • Average age of onset … years
  • 90% before … years
  • Life time prevalence: ..-..% general population
  • Lifetime competed suicide rates 10 – 15%
A
  • Sex: ♀ = ♂
  • Average age of onset 20 years
  • 90% before 30 years
  • Life time prevalence: 1-3% general population
  • Lifetime competed suicide rates 10 – 15%
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7
Q

Aetiology of Bipolar

  • Strong genetic component
    • Increased risk if 1st degree relative affected (up to 10%)
    • MZ twin concordance: …%
    • DZ twin concordance: …%
    • Heritability 60%
  • TRIGGERS
    • … stress
    • … disturbance
A
  • Strong genetic component
    • Increased risk if 1st degree relative affected (up to 10%)
    • MZ twin concordance: 60%
    • DZ twin concordance: 20%
    • Heritability 60%
  • TRIGGERS
    • Psychosocial stress
    • Sleep disturbance
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8
Q

Aetiology of Bipolar

  • Strong … component
    • Increased risk if 1st degree relative affected (up to …%)
    • …Z twin concordance: 60%
    • …Z twin concordance: 20%
    • Heritability 60%
  • TRIGGERS
    • Psychosocial stress
    • Sleep disturbance
A
  • Strong genetic component
    • Increased risk if 1st degree relative affected (up to 10%)
    • MZ twin concordance: 60%
    • DZ twin concordance: 20%
    • Heritability 60%
  • TRIGGERS
    • Psychosocial stress
    • Sleep disturbance
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9
Q

Aetiology of Bipolar

  • Strong genetic component
    • Increased risk if 1st degree relative affected (up to 10%)
    • MZ twin concordance: 60%
    • DZ twin concordance: 20%
    • Heritability …%
  • TRIGGERS
    • Psychosocial …
    • Sleep …
A
  • Strong genetic component
    • Increased risk if 1st degree relative affected (up to 10%)
    • MZ twin concordance: 60%
    • DZ twin concordance: 20%
    • Heritability 60%
  • TRIGGERS
    • Psychosocial stress
    • Sleep disturbance
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10
Q

Aetiology of Bipolar

  • Strong genetic component
    • Increased risk if … degree relative affected (up to 10%)
    • MZ twin concordance: 60%
    • DZ twin concordance: 20%
    • Heritability …%
  • TRIGGERS
    • Psychosocial stress
    • Sleep disturbance
A
  • Strong genetic component
    • Increased risk if 1st degree relative affected (up to 10%)
    • MZ twin concordance: 60%
    • DZ twin concordance: 20%
    • Heritability 60%
  • TRIGGERS
    • Psychosocial stress
    • Sleep disturbance
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11
Q

DSM-V criteria - BPAD

  • BPAD Type I:
    • 1+ manic episode (>… days)
    • (With or without major depressive episode)
  • BPAD Type II:
    • 1+ hypomanic episode (>… days)
      • 1 major depressive episode
    • (NO episodes of …)
A
  • BPAD Type I:
    • 1+ manic episode (>7 days)
    • (With or without major depressive episode)
  • BPAD Type II:
    • 1+ hypomanic episode (>4 days)
      • 1 major depressive episode
    • (NO episodes of mania)
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12
Q

DSM-V criteria - BPAD

  • BPAD Type I:
    • …+ manic episode (>7 days)
    • (With or without … … episode)
  • BPAD Type II:
    • 1+ … episode (>4 days)
      • 1 … … episode
    • (NO episodes of mania)
A
  • BPAD Type I:
    • 1+ manic episode (>7 days)
    • (With or without major depressive episode)
  • BPAD Type II:
    • 1+ hypomanic episode (>4 days)
      • 1 major depressive episode
    • (NO episodes of mania)
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13
Q

DSM-V criteria - BPAD

  • BPAD Type I:
    • 1+ manic episode (>…. days)
    • (With or without major depressive episode)
  • BPAD Type II:
    • 1+ …. episode (>… days)
      • 1 major depressive episode
    • (…. episodes of mania)
A
  • BPAD Type I:
    • 1+ manic episode (>7 days)
    • (With or without major depressive episode)
  • BPAD Type II:
    • 1+ hypomanic episode (>4 days)
      • 1 major depressive episode
    • (NO episodes of mania)
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14
Q

ICD-10 - BPAD

  • …+ episodes
    • Manic
    • Hypomanic
    • Major depressive
A
  • 2+ episodes
    • Manic
    • Hypomanic
    • Major depressive
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15
Q

DIG FAST medical mnemonic – symptoms of mania

  • D…
  • I….
  • Grandiosity
  • Flight of Ideas / racing thoughts
  • Action Increase – Excess Energy
  • S… changes – … need for …
  • Talkativeness – Pressure of Speech
A
  • DIGFAST
    • Distractibility
    • Indiscretion (Risk Taking Behaviour)
    • Grandiosity
    • Flight of Ideas / racing thoughts
    • Action Increase – Excess Energy
    • Sleep changes – Decreased need for sleep
    • Talkativeness – Pressure of Speech
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16
Q

DIG FAST medical mnemonic – symptoms of mania

  • Distractibility
  • Indiscretion (… Taking Behaviour)
  • G….
  • F…
  • Action Increase – … Energy
  • Sleep changes – Decreased need for sleep
  • Talkativeness – … of Speech
A
  • DIGFAST
    • Distractibility
    • Indiscretion (Risk Taking Behaviour)
    • Grandiosity
    • Flight of Ideas / racing thoughts
    • Action Increase – Excess Energy
    • Sleep changes – Decreased need for sleep
    • Talkativeness – Pressure of Speech
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17
Q

Hypomania

  • Elevated/irritable mood >… days
  • 3+ of: (4+ if mood …)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
A
  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
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18
Q

What does DIG FAST stand for?

A
  • Distractibility
  • Indiscretion (Risk Taking Behaviour)
  • Grandiosity
  • Flight of Ideas / racing thoughts
  • Action Increase – Excess Energy
  • Sleep changes – Decreased need for sleep
  • Talkativeness – Pressure of Speech

Acronym for Bipolar manic episodes

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19
Q

Define Hypomania

A
  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
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20
Q

Hypomania

  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased activity/restlessness
    • Increased …/… of …
    • Increased …
    • Distractibility
    • I…
    • Increased … energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
A
  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
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21
Q

Hypomania

  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased …/…
    • Increased …/pressure of speech
    • Increased sociability
    • D…
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild …, … behaviour
  • Leading to some interference with … …
A
  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
22
Q

Hypomania

  • …/… mood >4 days
  • …+ of: (4+ if mood …)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
A
  • Elevated/irritable mood >4 days
  • 3+ of: (4+ if mood irritable)
    • Increased activity/restlessness
    • Increased talkativeness/pressure of speech
    • Increased sociability
    • Distractibility
    • Insomnia
    • Increased sexual energy, overfamiliarity
    • Mild reckless, irresponsible behaviour
  • Leading to some interference with personal function
23
Q

Define Mania

A
  • >1 week (or any duration if hospitalised)
  • Predominantly elevated/irritable mood
  • 3+ of: (4 if mood irritable)
    • Increased activity/restlessness
    • Foolhardy/reckless behaviour
    • Distractibility
    • Talkativeness/pressure of speech
    • Reduced need for sleep
    • Flight of ideas/subjective feeling of racing thoughts
    • Increased self esteem or grandiosity
    • Psychotic symptoms
  • Leading to severe interference with personal function
24
Q

Mania

  • >… … (or any duration if hospitalised)
  • Predominantly elevated/irritable mood
  • 3+ of: (4 if mood irritable)
    • Increased activity/restlessness
    • Foolhardy/reckless behaviour
    • D…
    • Talkativeness/pressure of speech
    • … need for sleep
    • Flight of ideas/subjective feeling of racing thoughts
    • Increased self esteem or grandiosity
    • … symptoms
  • Leading to severe interference with personal function
A
  • >1 week (or any duration if hospitalised)
  • Predominantly elevated/irritable mood
  • 3+ of: (4 if mood irritable)
    • Increased activity/restlessness
    • Foolhardy/reckless behaviour
    • Distractibility
    • Talkativeness/pressure of speech
    • Reduced need for sleep
    • Flight of ideas/subjective feeling of racing thoughts
    • Increased self esteem or grandiosity
    • Psychotic symptoms
  • Leading to severe interference with personal function
25
_Mania_ * \>1 week (or any duration if hospitalised) * Predominantly .../.... mood * ...+ of: (... if mood irritable) * Increased activity/restlessness * Foolhardy/reckless behaviour * Distractibility * Talkativeness/pressure of speech * Reduced need for sleep * Flight of ideas/subjective feeling of racing thoughts * Increased self esteem or grandiosity * Psychotic symptoms * Leading to severe interference with personal function
* \>1 week (or any duration if hospitalised) * Predominantly elevated/irritable mood * 3+ of: (4 if mood irritable) * Increased activity/restlessness * Foolhardy/reckless behaviour * Distractibility * Talkativeness/pressure of speech * Reduced need for sleep * Flight of ideas/subjective feeling of racing thoughts * Increased self esteem or grandiosity * Psychotic symptoms * Leading to severe interference with personal function
26
_Psychotic symptoms in mania_ * Delusions - usually mood-... * Grandiose (fame, wealth, power…) * Persecutory (if irritable) * Hallucinations * ... person auditory * Formal ... disorder * Circumstantiality * Tangentiality * ... of ideas * Communication may be difficult!
* Delusions - usually mood-congruent * Grandiose (fame, wealth, power…) * Persecutory (if irritable) * Hallucinations * 2nd person auditory * Formal thought disorder * Circumstantiality * Tangentiality * Flight of ideas * Communication may be difficult!
27
_Psychotic symptoms in mania_ * Delusions - usually mood-congruent * ... (fame, wealth, power…) * ... (if irritable) * Hallucinations * 2nd person auditory * ... thought disorder * Circumstantiality * T... * Flight of ideas * Communication may be difficult!
* Delusions - usually mood-congruent * Grandiose (fame, wealth, power…) * Persecutory (if irritable) * Hallucinations * 2nd person auditory * Formal thought disorder * Circumstantiality * Tangentiality * Flight of ideas * Communication may be difficult!
28
_Hypomania vs mania_
29
_DSM-V criteria - BPAD_ * BPAD Type I: * ....+ manic episode * (With or without major depressive episode) * BPAD Type II: * ....+ hypomanic episode * + 1 major depressive episode * (NO episodes of mania)
* BPAD Type I: * 1+ manic episode * (With or without major depressive episode) * BPAD Type II: * 1+ hypomanic episode * + 1 major depressive episode * (NO episodes of mania)
30
_DSM-V criteria - BPAD_ * BPAD Type I: * 1+ manic episode * *(With or without major depressive episode?)* * BPAD Type II: * 1+ hypomanic episode * *(with or without major depressive episode?)* * (NO episodes of mania)
* BPAD Type I: * 1+ manic episode * (With or without major depressive episode) * BPAD Type II: * 1+ hypomanic episode * + 1 major depressive episode * (NO episodes of mania)
31
_DSM-V criteria - BPAD_ * BPAD Type I: * 1+ ... episode * (With or without major depressive episode) * BPAD Type II: * 1+ ... episode * + 1 major depressive episode * (NO episodes of mania)
* BPAD Type I: * 1+ manic episode * (With or without major depressive episode) * BPAD Type II: * 1+ hypomanic episode * + 1 major depressive episode * (NO episodes of mania)
32
_DSM-V criteria - BPAD_ * BPAD Type ...: * 1+ manic episode * (With or without major depressive episode) * BPAD Type ...: * 1+ hypomanic episode * + 1 major depressive episode * (NO episodes of mania)
* BPAD Type I: * 1+ manic episode * (With or without major depressive episode) * BPAD Type II: * 1+ hypomanic episode * + 1 major depressive episode * (NO episodes of mania)
33
_ICD-10 - BPAD_
* •2+ episodes * •Manic * •Hypomanic * •Major depressive
34
_BPAD II_ * Which gender more prevalent? * More difficult to Diagnose * Needs more careful history * ... symptoms may not be spontaneously reported * May need collateral * Important to Dx: * ... alcohol, substance misuse * ^frequency and severity of depressive episodes * May need different treatment – ... ... * BPAD II can progress to BPAD I
* **F \>M** * More difficult to Diagnose * Needs more careful history * **Hypomanic** symptoms may not be spontaneously reported * May need collateral * Important to Dx: * **Increased** alcohol, substance misuse * ^frequency and severity of depressive episodes * May need different treatment – **mood stabilisers** * BPAD II can progress to BPAD I
35
_BPAD II_ * Which gender more prevalent? * More difficult to Diagnose * Needs more careful history * ... symptoms may not be spontaneously reported * May need collateral * Important to Dx: * ... alcohol, substance misuse * ^frequency and severity of ... episodes * May need different treatment – ... ... * BPAD II can progress to BPAD I
* **F \>M** * More difficult to Diagnose * Needs more careful history * **Hypomanic** symptoms may not be spontaneously reported * May need collateral * Important to Dx: * **Increased** alcohol, substance misuse * ^frequency and severity of **depressive** episodes * May need different treatment – **mood stabilisers** * BPAD II can progress to BPAD I
36
_Subtypes of BPAD_ * Rapid cycling BPAD * ....+ episodes in single year * ... prognosis * Cyclothymia * Chronic, \>2 years * Periods of mild elation and depression
* Rapid cycling BPAD * 4+ episodes in single year * Poor prognosis * Cyclothymia * Chronic, \>2 years * Periods of mild elation and depression
37
_Subtypes of BPAD_ * Rapid cycling BPAD * ....+ episodes in single year * ... prognosis * Cyclothymia * Chronic, \>... years * Periods of mild ... and ...
* Rapid cycling BPAD * 4+ episodes in single year * Poor prognosis * Cyclothymia * Chronic, \>2 years * Periods of mild elation and depression
38
What is rapid cycling BPAD?
* 4+ episodes in single year * Poor prognosis
39
What is Cyclothymia?
* Chronic, \>2 years * Periods of mild elation and depression
40
_Differential diagnosis of mania_ * ... * Secondary to medical condition * Eg thyroid disease, MS, brain lesions * Delirium * Secondary to substance misuse * Secondary to medication eg steroids, levodopa * ... * Schizoaffective disorder * Schizophrenia * ... * BPAD * cyclothymia * ... * EUPD
* Organic * Secondary to medical condition * Eg thyroid disease, MS, brain lesions * Delirium * Secondary to substance misuse * Secondary to medication eg steroids, levodopa * Psychotic * Schizoaffective disorder * Schizophrenia * Affective * BPAD * cyclothymia * Personality * EUPD
41
_Differential diagnosis of mania_ * Organic * ... to medical condition * Eg thyroid disease, MS, brain lesions * Delirium * Secondary to ... misuse * Secondary to ... eg steroids, levodopa * Psychotic * ... disorder * Schizophrenia * Affective * ... * cyclo.. * Personality * E...
* Organic * Secondary to medical condition * Eg thyroid disease, MS, brain lesions * Delirium * Secondary to substance misuse * Secondary to medication eg steroids, levodopa * Psychotic * Schizoaffective disorder * Schizophrenia * Affective * BPAD * cyclothymia * Personality * EUPD
42
_Treatment of acute manic episodes: General principles_ * Reduce ... stimuli * Assess for possible contributing substances * Recreational/prescribed drugs * ... ... screen * Limit potential ... behaviour * Eg Limit access to cars, bank accounts, credit cards * Consider consequences of reckless behaviour * Sexual health - emergency contraception/STI screen
* Reduce external stimuli * Assess for possible contributing substances * Recreational/prescribed drugs * Urine drug screen * Limit potential reckless behaviour * Eg Limit access to cars, bank accounts, credit cards * Consider consequences of reckless behaviour * Sexual health - emergency contraception/STI screen
43
_Treatment of acute manic episodes: General principles_ * Reduce external stimuli * Assess for possible contributing substances * .../... drugs * Urine drug screen * Limit potential ... behaviour * Eg Limit access to cars, bank accounts, credit cards * Consider consequences of ... behaviour * ... health - emergency contraception/STI screen
* Reduce external stimuli * Assess for possible contributing substances * Recreational/prescribed drugs * Urine drug screen * Limit potential reckless behaviour * Eg Limit access to cars, bank accounts, credit cards * Consider consequences of reckless behaviour * Sexual health - emergency contraception/STI screen
44
_Treatment of acute manic episodes_ * STOP any ... * 1) Antipsychotic- 1 of: * O... * H... * QUETIAPINE * RISPERIDONE * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) Valproate + AP * Short term benzodiazepine for sedation
* STOP any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * HALOPERIDOL * QUETIAPINE * RISPERIDONE * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) Valproate + AP * Short term benzodiazepine for sedation
45
_Treatment of acute manic episodes_ * STOP any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * HALOPERIDOL * Q... * R... * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) ... + AP * 4) Valproate + AP * Short term ... for sedation
* STOP any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * HALOPERIDOL * QUETIAPINE * RISPERIDONE * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) Valproate + AP * Short term benzodiazepine for sedation
46
_Treatment of acute manic episodes_ * STOP any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * H.. * QUETIAPINE * R... * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) ... + AP * Short term benzodiazepine for ...
* STOP any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * HALOPERIDOL * QUETIAPINE * RISPERIDONE * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) Valproate + AP * Short term benzodiazepine for sedation
47
_Treatment of acute manic episodes_ * ... any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * HALOPERIDOL * Q... * RISPERIDONE * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) Valproate + AP * Short term ... for sedation
* STOP any antidepressant * 1) Antipsychotic- 1 of: * OLANZAPINE * HALOPERIDOL * QUETIAPINE * RISPERIDONE * N.B. NICE guidance – there may be better choices for your individual patient * 2) Alternative antipsychotic (AP) * 3) Lithium + AP * 4) Valproate + AP * Short term benzodiazepine for sedation
48
BPAD - If already taking lithium or valproate: * Check ... * ... dose * .. level? * May add ...
* Check compliant * Optimise dose * Li level? * May add AP
49
_Management – BPAD_ * M... ... * ... antipsychotics * E... * Psychological – CBT, psychoeducation, psychodynamic, family therapy, relapse prevention * Antidepressants? - risk of manic switch
* Mood stabilisers * Atypical antipsychotics * ECT * Psychological – CBT, psychoeducation, psychodynamic, family therapy, relapse prevention * Antidepressants? - risk of manic switch
50
_Management – BPAD_ * Mood ... * Atypical ... * E... * Psychological – CBT, psychoeducation, psychodynamic, family therapy, relapse prevention * Antidepressants? - risk of ... switch
* Mood stabilisers * Atypical antipsychotics * ECT * Psychological – CBT, psychoeducation, psychodynamic, family therapy, relapse prevention * Antidepressants? - risk of manic switch
51
_Psychiatric history outline in BPAD_

Psychiatry and Elderly Medicine (14 decks)

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