Bipolar Affective Disorder Flashcards
What is bipolar affective disorder?
Characterised by recurrent episodes of depression and mania or hypomania
What age do symptoms typically start in bipolar disorder?
Under 25
What is bipolar disorder associated with?
Suicide
What are depressive episodes?
Episodes which feature :
- Low mood
- Anhedonia
- Low energy
Can be severe
What are manic episodes?
Episodes involving excessively elevated mood and energy
Significantly impacts their normal functions
Very disinhibited
Unable to function
More than 7 days
What are hypomanic episodes?
Milder symptoms of mania without significant impact on their function
Only lasts a few days
Able to continue functioning
No feelings of grandiosity
Less than 7 days
What are mixed episodes?
Mix of symptoms or rapid cycling between mania and depression
What are features of mania?
- Elevated mood
- Irritability
- Energetic
- Insomnia
- Grandiosity, ambitious plans, excessive spending, risk taking
- Disinhibition
- Flight of ideas
- Pressured speech
- Psychosis
How is bipolar disorder diagnosed?
Diagnosis made by specialist
Based on
ICD-11
What is Bipolar affective disorder I?
Two distinct mood episodes
Involves at least one episode of mania
What is Bipolar affective disorder II?
One episode of major depression
One episode of hypomania
What is cyclothymia?
Milder symptoms of hypomania and low mood
Symptoms not severe enough to significantly impact their function
What is unipolar depression?
Person only has episodes of depression without hypomania or mania
How is an acute episode of bipolar disorder managed?
Secondary care specialists should manage it
Requires referral for urgent mental health assessment or hospital admission
How is an acute manic episode treated?
Antipsychotics (olanzapine, quetiapine, risperidone or haloperidol) first line
Mood stabilisers
Lithium and sodium valproate
Existing antidepressants tapered and stopped
What treatment options are used for an acute depressive episode?
Olanzapine + fluoxetine
Antipsychotics (olanzapine or quetiapine)
Lamotrigine
What is the long-term management of bipolar disorder?
Lithium
Why are serum lithium levels monitored so closely?
Lithium toxicity occurs if dose and levels too high
Target range is 0.6-0.8mmol/L
When are serum lithium levels monitored?
12 hours after most recent dose
After changing dosage in lithium use when should serum lithium levels be checked?
Checked after 1 week and weekly until the levels are stable
What are the adverse effects of lithium?
Fine tremor
Weight gain
CKD
Hypothyroidism and goitre
Hyperparathyroidism and hypercalcaemia
Nephrogenic diabetes insipidus
What are some signs of lithium toxicity?
Coarse tremor
Nausea
Vomiting
Confusion
Ataxia
Muscle weakness
Seizures
Why can you get hypothyroidism and goitre in lithium use?
Inhibits production of thyroid hormones
What are some alternatives to lithium for long-term management of bipolar disorder?
Sodium valproate
Olanzapine
What are the strict rules in place for sodium valproate and why?
Teratogenic
Causes neural tube defects and developmental delay if used in pregnancy
Strictly avoided in childbearing women unless no suitable alternatives
What are the main side effects of sodium valproate?
VALPROATE
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Really big (weight gain)
Oedema
Anorexia
Tremor
Enzyme inhibiton
How does sodium valproate work?
Blocks voltage-dependent sodium channels to suppress high frequency neuronal firing
Inhibitior of CYP hepatic enzmyes
What must a female patient of childbearing age do when taking sodium valproate?
- Patient must use effective contraception
- Sign an annual risk acknowledgement form
What does duration of untreated psychosis lead to?
Leads to poorer prognosis
Why does bipolar have a high rate of suicide?
After recovering from mania, patients often highly embarrassed from their symptoms during mania
Or if they bought expensive items e.g. a car and are financially struggling
What is a grandiose delusion?
Hightened sense of self-worth/power/knowledge or believes they have powers no one else does
What is a Biazarre delusion?
Perosn adamant about a belief that is not possible, understable or related to normal life
What is circumstantiality?
Inability to answer a question without giving excessive, unnecessary detail
How does carbamazepine work?
Bind to voltage-dependent sodium channels to inhibit high frequency neuronal firing
Induces liver enzymes
What serious condition can carbamazepine cause?
Steven-Johnson Syndrome
Avoid in South asians / HLAB1502 enzyme
What are the side effects of carbamazepine?
Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Bone marrow suppression
ADH release
Eosinophilia
