Bipolar Affective Disorder Flashcards
Bipolar mood or affective disorder is characterised by
recurrent episodes of mania and depression in h tv r same patient at different times
Bipolar affective disorder was earlier known as
Manic depressive psychosis
Bipolar type 1
characterised by episodes of severe main and severe depression
Bipolar type 2
characterised by episodes of hypomania(not requiring hospitalisation) and severe depression
Theories of aetiology of bipolar
- Genetic hypothesis
- Biochemical theories
- Neuroendocrine theories
- Sleep studies
- Brain imaging
life time risk for the first degree relatives getting bipolar disorder is
25%
children with one parent having bipolar disorder has a risk of __, children with both parents having bipolar disorder has a risk of__
27%
74%
Risk of monozygotic twins is__
Dizygotic twins is __
65%
20%
Biochemical theories
Catecholamine’s abnormalities in one or more sites in the brain
brain imaging findings in bipolar disorder
- ventricular dilatation
- white matter hyper-intensities
- changes in blood flow and metabolism in prefrontal cortex, anterior cingulate cortex and caudate
clinical features of bipolar depressive form
- constantly feeling sad or worthless
- sleeping too much or too little
- feeling tired and having little energy
- problems focusing
- thoughts of suicide
clinical features of bipolar manic form
- increased energy levels
- less need for sleep
- easily distracted
- nonstop talking
- increased self confidence
- focused on getting things done but does not accomplish much
- is involved in risky activities even though bad things may happen
average manic episode lasts for __
average depressive episode lasts of __
3-4 months
4-6 months
with rapid institution of treatment symptoms of mania are controlled within __ and depression within__
2 weeks
6-8 weeks
Good prognostic factors
- acute or abrupt onset
- typical clinical features
- severe depression
- well adjusted premorbid personality
- good response to treatment
poor prognostic factors
- co morbid medical disorders, personality disorder or alcohol dependence
- double depression
- catastrophic stress or chronic ongoing stress
- unfavourable early environment
- marker hypochondriacal features, or mood incongruent psychotic features
- poor drug compliance
management of bipolar
- antidepressants
- ect
- lithium
- antipsychotics
- other mood stabilisers
examples of antidepressants
imipramine, amitryptyline, nortryptyline, clomipramine, fluoxetine, paroxetine, sertraline, escitalopram, mirtazepine
drug of choice for manic episodes and preventing further episodes in bipolar disorder
Lithium
lag period before appreciable improvement on lithium
1-2 weeks
usual dose of LiCO3 per day for bipolar
900-1500mg
acute symptoms of lithium toxicity
muscle twitchings, drowsiness, delirium, coma and convulsions, vomiting, severe diarrhoea, albuminuria, hypotension, cardiac arrhythmia
examples of antipsychotics
risperidone, olanzepine, quetipine, haloperidol, and chlorpromazine
indications for antipsychotics
- acute manic episode
- delusional depression
other mood stabilisers
sodium valproate(1000-3000mg/day)
carbamazepine (600-1600mg/day)
lorazepam and clonazepam
topiramate
lamotrigine
t3 and t4 as adjuncts in rapid cyclers
other mood stabilisers
sodium valproate(1000-3000mg/day)
carbamazepine (600-1600mg/day)
lorazepam and clonazepam
topiramate
lamotrigine
t3 and t4 as adjuncts in rapid cyclers
