Bipolar affective disorder Flashcards
What is the scale of mood disorders?
What is the ICD-10 criteria for bipolar affective disorder?
At least 2 episodes one of which must be manic/hypomanic or mixed, with recovery complete between the two episodes.
NB (?): Criteria for the depressive episode is the same as for unipolar depresson, and criteria for mania/hypomania episode if the same as for unipolar hypomania/mania.
What is a mixed episode in bipolar affective disorder (BPAD)?
Mixed affective episode = occurrence of BOTH hypomanic/manic AND depressive symptoms in a single episode present everyday for at least 2 weeks.
What are the types of BPAD?
Type 1 - one episode of mania +/- depression
Type 2 - one episode of hypomania +/- depression
How common is BPAD? When is the mean age of onset?
1.5% point prevalence
Lifetime prevalence for type 1 is 1% and for type 2 is 1.1%
Mean age of onset for:
- type 1 is 18.2years
- type 2 is ~20 years
What is a major risk with BPAD for the individual?
Suicide rate in BPAD is ~15-18 times greater than in the general population
How common is mania after having an episode of depression?
10% of those with a depressive episode will go on to develop an episode of mania within 10 years
What are some risk factors for BPAD?
- Upper social classes have higher incidence
- Genetics - first degree relative increases risk 7-fold and MZ twins show 33-90% concordance
- No sex differences
- No ethnic differences
What is the peak age of onset of BPAD?
Peaks at 15-19 and 20-24
Mean age of onset is 21 years
How is a manic episode diagnosed?
A…:
- Elevated, expansive, irritable mood + abnormal for the individual
- Prominent change in mood
- Sustained for at least 1 week (unless hospitalised)
B: …AND at least 3 (4 if only irritable mood) of the following, leading to interference in daily living:
- Activity/physical restlessness
- Talkativeness
- Flight of ideas or ‘thoughts racing’
- Distractibility or constant changes in activity/plans
- Grandiosity or inflated self-esteem
- Marked sexual energy/sexual indiscretions
- Loss of social inhibitions (leading to inappropriate behaviour)
- Reckless behaviour not recognised as such by patient
- Decreased need for sleep
When do psychotic features appear in mania? Are they mood congruent?
They are associated with severe mania
Yes, usually mood congruent
Give 4 psychotic features of mania.
Delusions
Incomprehensible speech - due to pressured speech
Self neglect - usually due to preoccupation with thoughts and extravagant themes so they may not eat or drink
Catatonic behaviour - manic stupor
Total loss of insight
Give two types of delusions which are common in mania with psychosis.
Grandiose Delusions: grandiose ideas become delusions and are usually related to some form of identity or role e.g. special powers or religious content.
Persecutory delusions: suspicion may develop into well formed persecutory delusions
How do you diagnose a hypomanic episode?
A:…
- Elevated or irritable mood
- To a degree that is abnormal for the individual concerned
- Sustained for at least 4 ocnsecutive days
B: …AND at least 3 of the following present leading to some interference with impaired functioning in daily living:
- Activity/physical restlessness
- Talkativeness
- Overfamiliarity/increased sociability
- Recklessness, mild overspending or irresponsible behaviour
- Sexual energy increased
- Distractibility/difficulty concentrating
- Decreased need for sleep
What is the difference between mania and hypomania?
- Degree of functional impairement - hospitalisation may be required in mania due to risk to self or others; unlikely in hypomania
- Duration - 4 days for hypomania and 7 days for mania but this is arbitrary as most studies have shown that most hypomanic episodes in bipolar type 2 last for <4 days.
- Psychosis - may occur in mania but does not occur in hypomania
What are some secondary causes of mania?
Organic brain damage - especially right hemisphere (more common in elderly)
Medication - Levo-Dopa, corticosteroids
Illicit drugs - stimlants, street drugs cause this if the mood state significantly outlasts the drugged state (then BPAD can be diagnosed)
Endocrine - Hyperthyroidism sometimes presents as hypomanic or agitated (hypothyroidism usually presents like depression)
What is the bio-psycho-social management of BPAD?
Bio - mood stabiliser (see lecture)
Psycho - psychoeducation, family therapy and individual/group psychotherapy
Social - supported employmen programmes, adapting in education systems, regular engagement
A 34 year old South Asian woman presents with a two month history of elated mood, increased energy and increased productivity in her marketing business. Her mother has a history of anxiety and her father has a history of bipolar affective disorder. Which of the following is the most influential factor in her presentation.
- A. Her family history
- B. Her gender
- C. Her ethnicity
- D. Her age
- E. Her occupation
FH
What is cyclothymia?
Cycling of subthreshold symptoms of elevated and depressed mood over a period of at least 2 years
