Bipolar affective disorder Flashcards
What is bipolar affective disorder?
A disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of hypomania or mania, and on others, depression.Repeated episodes of hypomania or mania only are still classified as bipolar.
What is the old name for bipolar disorder?
Manic depression
What is euthymia?
Normal mood state
What is depression?
Unremitting, pervasie unhappiness with loss of ability to experience positive emotions, reduced energy and negativity
What is shown?
Euthymia (Normal variation)
What is shown?
Dysthymia
What is shown?
Hyperthymia
What is shown?
Cyclothymia
What is shown?
Bipolar disorder
What is shown?
Depression
Describe the aetiology of bipolar disorder
Late teens - early 20s
Rare in those over 60
Family history of BPAD
What are some common comorbidities in BPAD?
anxiety disorders, substance misuse, personality disorders, eating disorders, schizoaffective disorder, schizophrenia
How long do manic episodes usually last if untreated?
50% manic episodes last 2 to 7 months (median = 3 months) if untreated
What is the lifetime rate of suicide in those with BPAD?
8-20%
What are the 2 classes of bipolar disorder?
Bipolar I
Bipolar II
What is bipolar I?
This type presents with manic episodes (most commonly interspersed with major depressive episodes)
The manic episodes are severe and result in impaired functioning and frequent hospital admissions
What is bipolar II?
Patients do not meet the criteria for full mania and are described as hypomanic
This type is often interspersed with depressive episodes and represents the most common form of illness
ICD-11 criteria for a hypomanic episode
- A persistent mood state lasting for at least several days
- Characterised by persistent elevation of mood or increased irritability as well as increased activity or a subjective experience of increased energy,
- Accompanied by other characteristic symptoms such as:
- increased talkativeness,
- rapid or racing thoughts,
- increased self-esteem,
- decreased need for sleep,
- distractibility,
- impulsive or reckless behaviour.
- The symptoms represent a change from the individual’s typical mood, energy level, and behaviour but are not severe enough to cause marked impairment in functioning.
ICD-11 criteria for manic episode
- An extreme mood state lasting at least one week
- Euphoria, irritability, or expansiveness,
- Increased activity or a subjective experience of increased energy
- Accompanied by other characteristic symptoms such as:
- rapid or pressured speech,
- flight of ideas,
- increased self-esteem or grandiosity,
- decreased need for sleep,
- distractibility,
- impulsive or reckless behaviour,
(e.g. loss of normal social inhibitions, overfamiliarity, excess spending, sexual indiscretions / risk taking, dangerous driving, harmful business or personal decisions) - rapid changes among different mood states (i.e., mood lability)
Mania vs hypomania
ICD-11 definition of a mixed episode
Characterised by the presence of several prominent manic and several prominent depressive symptoms consistent with those observed in manic episodes and depressive episodes, which either occur simultaneously or alternate very rapidly (from day to day or within the same day)
MSE - BPAD - Appearance and behaviour
- Bright clothes
- Distractibility
- Loss of normal social inhibitions/overfamiliarity
MSE - BPAD - Speech
- Increased talkativeness (hard to interrupt)
- Punning and clang associations
MSE - BPAD - Thoughts
- Increased flow (lots of thoughts)
- Flight of ideas and loosening of associations
- Grandiosity
1st line management of an acute manic episode
Atypical antipsychotic e.g. olanzapine, quetiapine, or risperidone
2nd line management of an acute manic episode
Valproate, lamotrigine, or lithium
Symptom control used in acute manic episodes?
Benzodiazepines - Agitation
Z-drugs - Insomnia
1st line management of an acute bipolar depression
Atypical antipsychotic e.g. quetiapine or olanzapine
Antidepressants may be given
Who is NOT given antidepressants during an acute bipolar depressive episode?
Those who have a history of rapid cycling or who have had a recent manic or hypomanic episode
What are some mood stabilisers used in maintenance of BPAD?
Lithium (Gold standard)
Aripiprazole
Quetiapine
What are some conditions which BPAD may be mistaken for?
Unipolar depression
Emotionally unstable personalty disorder
ADHD
Bipolar disorder vs unipolar depression
Characteristics of bipolar compared with unipolar depression include:
- significantly earlier age of onset (often in mid-teens),
- more recurrences,
- atypical features e.g. hypersomnia
- psychotic features & psychomotor retardation
- mixed affective state,
- post-partum illness in women,
- family history of bipolar disorder,
- family history of completed suicide
- poor response to multiple antidepressant trials
Bipolar vs EUPD
- Both have “mood swings” and impulsivity, both can have deliberate self-harm, both start in adolescence
- Bipolar – clear evidence of hypomanic symptoms more likely to have family history of bipolar disorder
- EUPD – mood variation from OK to low/anxious / angry higher likelihood of childhood trauma and repeated DSH (but childhood trauma is a generalised risk factor for mental health problems)
- Bipolar disorder and EUPD can also co-exist
Bipolar vs ADHD
- Bipolar – symptoms have a pattern / episodic onset in adolescence
- ADHD – symptoms are continuous (although can vary in intensity) onset as a child
- But note high rates of comorbidity between ADHD and Bipolar disorder (10% of those with ADHD get a Bipolar diagnosis; 16% of adults with Bipolar disorder have ADHD)
