Bipolar Affective Disorder Flashcards
What is Bipolar Affective Disorder (BAD)?
AKA manic depression. Involves periods of both depression and mania. May have ful return to normal in between. Pattern and frequency of episodes are variable.
What is the aetiology of BAD?
Genetic factors. Incidence is higher in higher social classes, urban and ethnic minorities. Increased risk in early post partum. Recuurrence rate high especially if first episode in adolescence. Sleep disruption caused by shift work etc may precipitate manic episode.
What may you find in the history/ exam of someone with BAD?
Hypomania
Mania with psychosis
Depression
What are symptoms of hypomania?
· Mild mood elevation
· Increased activity/eneergy
· Low sleep
· Talkative
· Overafmiliarty
· Increased libido
What are the symptoms of mania with psychosis?
· Elated mood
· Increased energy
· Pressure speech
· High creativity/efficiency
· Sex disinhibition
· Reduced sleep
· + psychosis: grandiose delusions and auditory hallucinations
What are the symptoms of depression
· Appearance: birght and outlandish/neglected.
· Behavior: Overfamiliar/friendly.
· Mood: Elated that can be irritable/angry.
· Speech: loud, pressured.
· Thought: grandiose, persecutory delusions.
· Perceptions, hallucinatons, mostly auditory.
What investigations would you do for BAD?
Exclude other causes: substance use, SOL, TFT, corticosteroids, anabolic steroids, FBC, UE, LFT, Ca, Glucose, Urine drug screen.
What are the complications/ prognosis of BAD?
10% suicide rate, substance misuse, non compliance with prophylaxis leading to relapses, rapid cycling escalation (4+ episodes per year).
Most relapses due to poor compliance. Recovery between episodes is often complete. 90% relapse rae even with good prophylaxis. Median duration of untreated mania is 4 months, .followed by depression for 6 months. Manic episodes become less frequent and shorter, whereas depressive ones lengthen.
Poor prognostic factors include: early onset, poor compliance, persistent depressive symptoms, severe mania, non response, comorbid PD, rapid cycling, substance misuse.
What is the acute management of mania and depression?
· Mania
o First line
§ Olanzapine
§ Quetiapine
§ Aripiprazole
§ Lithium
§ Valporate
o Second line
§ Carbamazepine
· Depression
o First line
§ Quetiapine
§ Lamotrigine
o Second line
§ Lithium
o Combination therapy
What is the long term management for BAD?
o No clear evidence-based guidelines
o CBT treatment, Suicide prevention
o Neuroprotection
§ Lithium
· Vs glutamate/NMDA, Ca, beta-amyloid
§ Valporate
· Vs oxidative stress, haemorrhage, glutamate excitotoxicity
§ Lamotrigine
