Bipolar affective disorder

Question 1

What is bipolar affective disorder?

Answer 1

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.

Question 2

What is the old name for bipolar disorder?

Answer 2

Manic depression

Question 3

What is euthymia?

Answer 3

Normal mood state

Question 4

What is depression?

Answer 4

Unremitting, pervasie unhappiness with loss of ability to experience positive emotions, reduced energy and negativity

Question 5

What is shown?

Answer 5

Euthymia (Normal variation)

Question 6

What is shown?

Answer 6

Dysthymia

Question 7

What is shown?

Answer 7

Hyperthymia

Question 8

What is shown?

Answer 8

Cyclothymia

Question 9

What is shown?

Answer 9

Bipolar disorder

Question 10

What is shown?

Answer 10

Depression

Question 11

Describe the aetiology of bipolar disorder

Answer 11

Late teens - early 20s
Rare in those over 60
Family history of BPAD

Question 12

What are some common comorbidities in BPAD?

Answer 12

anxiety disorders, substance misuse, personality disorders, eating disorders, schizoaffective disorder, schizophrenia

Question 13

How long do manic episodes usually last if untreated?

Answer 13

50% manic episodes last 2 to 7 months (median = 3 months) if untreated

Question 14

What is the lifetime rate of suicide in those with BPAD?

Answer 14

8-20%

Question 15

What are the 2 classes of bipolar disorder?

Answer 15

Bipolar I
Bipolar II

Question 16

What is bipolar I?

Answer 16

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

Question 17

What is bipolar II?

Answer 17

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

Question 18

ICD-11 criteria for a hypomanic episode

Answer 18

• 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.

Question 19

ICD-11 criteria for manic episode

Answer 19

• 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)

Question 20

Mania vs hypomania

Answer 20

Question 21

ICD-11 definition of a mixed episode

Answer 21

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)

Question 22

MSE - BPAD - Appearance and behaviour

Answer 22

• Bright clothes
• Distractibility
• Loss of normal social inhibitions/overfamiliarity

Question 23

MSE - BPAD - Speech

Answer 23

• Increased talkativeness (hard to interrupt)
• Punning and clang associations

Question 24

MSE - BPAD - Thoughts

Answer 24

• Increased flow (lots of thoughts)
• Flight of ideas and loosening of associations
• Grandiosity

Question 25

1st line management of an acute manic episode

Answer 25

Atypical antipsychotic e.g. olanzapine, quetiapine, or risperidone

Question 26

2nd line management of an acute manic episode

Answer 26

Valproate, lamotrigine, or lithium

Question 27

Symptom control used in acute manic episodes?

Answer 27

Benzodiazepines - Agitation
Z-drugs - Insomnia

Question 28

1st line management of an acute bipolar depression

Answer 28

Atypical antipsychotic e.g. quetiapine or olanzapine
Antidepressants may be given

Question 29

Who is NOT given antidepressants during an acute bipolar depressive episode?

Answer 29

Those who have a history of rapid cycling or who have had a recent manic or hypomanic episode

Question 30

What are some mood stabilisers used in maintenance of BPAD?

Answer 30

Lithium (Gold standard)
Aripiprazole
Quetiapine

Question 31

What are some conditions which BPAD may be mistaken for?

Answer 31

Unipolar depression
Emotionally unstable personalty disorder
ADHD

Question 32

Bipolar disorder vs unipolar depression

Answer 32

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

Question 33

Bipolar vs EUPD

Answer 33

• 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

Question 34

Bipolar vs ADHD

Answer 34

• 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)