Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Bipolar affective disorder > Flashcards

Bipolar affective disorder Flashcards

1
Q

What is hypomania

A 
Symptoms need to be present for at least 4 days
Mild elevation of mood
Increased energy
Mild risk-taking, overspending
Overfamiliarity
Distractibility
Increased sexual energy
Decreased need for sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is mania

A

Symptoms present for at least 1 week or severe enough for hospital admission

Mood is elevated, expansive, irritable
Increased activity
Reckless behavior
Disinhibition
Marked distractibility
Markedly increased sexual energy
Sleep severely impaired or absent
Grandiosity
Flight of ideas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is mania with psychosis

A

Mania plus:
Delusions that are often mood congruent (eg. grandios vs. persecutory when irritated)

Mood congruent, 2nd person auditory hallucinations (less frequent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Classify different mood changes

A

1 episode of mania = Acute mania
2 episodes of mania = bipolar affective disorder
1 episode of mania + 1 episode of depression = bipolar affective disorder
2 episodes of depression = recurrent depressive disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is dysthymia?

A

Chronically low mood, but not low enough to justify a diagnosis of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is cyclothymia?

A

Changes in mood that do not meet criteria for mania or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the organic differentials for bipolar affective disorder?

A 
Substance misuse (eg. steroids)
Hyperthyroidism (very severe)
Space occupying lesion (frontal lobe)
Metabolic disorders
Epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aetiology of bipolar affective disorder

A

Genetics (predispose) - if relative with bipolar, higher chance of bipolar, schizoaffective or unipolar depression

Life events (precipitate) - prolonged stress, vulnerability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prognosis of bipolar affective disorder

A

Average length of manic episode is 6 months
At least 90% will have a further mood disturbance

Typically, 10 mood disturbances over 25 years

Recovery from acute episodes is good, but long term prognosis poor:
<20% achieve 5 years of clinical stability with good social/occupational performance

20-30times more likely to die of suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Biological treatment of mania

A

Offer anti-psychotic (haloperidol, olanzapine, risperidone, quetiapine)
Consider lithium or valproate
Consider benzodiazepines like lorazepam or diazepam for mood disturbances

Stop any anti-depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Psychological management of mania

A

Psychoeducation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Social management of mania

A 
Consider Mental Health Act
Consider inpatient admission
Calm, low-stimulus environment
Advise not to make any decisions
Advise to maintain relationships with carers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What organic cause of depression should be remembered in long-term lithium use

A

hypo-thyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of bipolar depression

A

Consider mood stabiliser (lithium, valproate, lamotrigine)
SSRI can be used, but only with an anti-manic agent
Consider 2nd generation antipsychotics (eg. olanzapine, quetiapine)

CBT
Psychoeducation

Carer support
Inpatient admission if risk
Work around social inclusion
Support with regard to education, training, employment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What to do if lithium ineffective?

A

Add sodium valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If lithium is intolerable?

A

Consider valproate or olanzapine instead

17
Q

In a women with child-bearing age, what should be considered?

A

Lithium and valproate are teratogenic

Consider antipsychotic as first-line mood-stabilisier

18
Q

What physical health monitoring is important in bipolar affective disorder?

A

Offer a healthy eating/physical activity programme
Weight and other cardiovascular and metabolic indicators of morbidity should be monitored, at least annually
Some medications have their own monitoring requirements (e.g. lithium - levels weekly whilst initiating and after any dose change and every 3 months thereafter; also need to check U&E and TFT every 6 months)

Provide advice with regard to contraception and folic acid if lithium, valproate, carbamazepine are prescribed to women of childbearing age.

19
Q

List the “mood stabilisers”

A

Lithium
Valproate
Carbamazepine
Lamotrigine

A number of antipsychotics can now also be used: quetiapine, olanzapine, aripiprazole

20
Q

Indications for mood stabilisers

A

Prophylaxis in bipolar:
Single manic episode associated with significant risk
Illness with significant impact on functioning
Two or more acute episodes

Treatment of bipolar depression
Augmentation for antidepressants in treatment-resistant depression

NOT first line in acute mania/hypomania

21
Q

When is lithium indicated?

A

Acute mania/hypomania (good evidence)
Prophylaxis in bipolar disorder
Bipolar depression
Treatment-resistant depression

22
Q

Therapeutic window of lithium

A

Narrow (0.4-1.2mmol/L)

Monitor after a minimum of 5 days

23
Q

Side effects of Lithium

A 
GI upset
Fine tremor
Polyuria
Polydipsia
Metallic taste in mouth
Weight gain
Oedema
24
Q

Toxic effects of lithium

A 
Diarrhoea
Course tremor
Ataxia
Dysarthria
Nystagmus
Confusion
Convulsions

Toxicity is associated with low sodium diets, dehydration, drug interactions (NSAIDS, ACE inhibitors, thiazide and loop diuretics) and some physical illnesses such as Addison’s disease

25
Q

What monitoring is required with Lithium?

A

lithium is known to be nephrotoxic and thyrotoxic

Lithium levels every 3 months
TFTs every 6 months
U&Es every 6 months

26
Q

Lithium in pregnancy

A

The majority of the malformations are cardiac defects (ASD and VSDs). The most widely quoted, but not the most common, is Ebstein’s anomaly (abnormality of the tricuspid valve), with lithium exposure in the first trimester the rate of Ebstein’s anomaly increases from 0.00005% to 0.1%.

27
Q

How does valproate work?

A

inhibits catabolism of GABA, alters synaptic plasticity, promotes BDNF expression and reduces levels of protein kinase C

28
Q

Indications of valproate

A

Acute mania/hypomania

Prophylaxis in Bipolar (weaker evidence than lithium)

29
Q

Adverse outcomes with valproate in pregnancy (always prescribe adequate contraception eg. Mirena coil)

A 
Congenital malformations (10%)
Low verbal IQ (30%)
Neural tube defects
Autism
Valproate syndrome
30
Q

Indications for lamotrigine

A

Prophylaxis in bipolar disorder (limited evidence)

Bipolar depression
Augmentation of antidepressants in treatment-resistant depression

31
Q

Lamotrigine in pregnancy

A

Probably the least teratogenic

However, risk of cleft lip/palate if first-trimester exposure

32
Q

Mechanism of action of carbamazepine

A

arbamazepine blocks voltage-dependent sodium channels.

33
Q

Indications for carbamazepine

A

Acute mania/hypomania (weaker evidence than lithium or valproate)
Prophylaxis in bipolar disorder (weak evidence)
Bipolar depression

Psychiatry (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions