Bipolar affective disorder Flashcards
Define bipolar affective disorder.
chronic MH disorder characterised by periods of mania/ hypomania alongside episodes of depression.
What are the 2 types of bipolar?
Type I: mania + depression (most common)
Type II: hypomania + depression
What is a manic episode?
abnormally elevated mood/ irritability +/- psychotic Sx
severe functional impairment or psychotic Sx for >,7 days
Give 8 signs and symptoms of a manic episode
Abnormally elevated mood, extreme irritability, +/-aggression.
Increased energy, restlessness, + decreased need for sleep
Pressure of speech or incomprehensible speech.
Flight of ideas or racing thoughts.
Distractibility, poor concentration.
Increased libido, disinhibition, + sexual indiscretions.
Extravagant or impractical plans
Psychotic Sx: delusions (usually grandiose) or hallucinations (usually voices).
What is a hypomanic episode?
Sx >4d
Not severe enough to cause impairment in social or occupational function or necessitate hospitalization
NO psychotic features.
Give 4 signs and symptoms of hypomania
Mild elevation of mood/ irritability.
Increased energy + activity, may lead to increased performance at work or socially.
Feelings of well-being, or physical + mental efficiency.
Increased sociability, talkativeness, + over-familiarity.
What is a depressive episode ?
> ,2w depressed mood or loss of interest in nearly all activities (or irritability in children + adolescents),
+ >, 4 additional depressive Sx
What is a mixed episode?
mixture
or
rapid alternation of manic + depressive Sx
Explain the aetiology of bipolar affective disorder.
Genetic factors.
Environmental triggers
Summarise the epidemiology of bipolar affective disorder.
Lifetime risk 2%.
First episode in late teens/ early 20s.
How would a bipolar affective disorder patient present?
Appearance: Bright + outlandish/ neglected.
Behavior: Overfamiliar/ friendly.
Mood: Elated that can be irritable/ angry.
Speech: Loud, pressured.
Thought: Grandiose, persecutory delusions.
Perceptions: Hallucinatons, mostly auditory.
What are investigations for bipolar affective disorder?
Exclude other causes:
TFT
Corticosteroids/ Anabolic steroids
FBC, U+Es, LFTs, Ca2+
Glucose
Substance use/ Urine drug screen.
SOL
What is the acute management for mania in first presentation of bipolar affective disorder?
STOP (taper) drugs that may induce Sx e.g. anti-depressants, steroids
Monitor food + fluid intake
Olanzapine, Quetiapine or Risperidone
+
Short course BZOs: Lorazepam
+/- Lithium
What is the acute management for mania in patients already on treatment of bipolar affective disorder?
Optimise medication
Check compliance
Adjust dose
Consider adding antipsychotic
What is the long-term management of bipolar disorder?
Mood stabiliser
+/- Antipsychotics
Psychological intervention
Social intervention
