Bipolar Affective Disorder Flashcards
What is the first part (A)of the ICD-10 criteria for diagnosing a manic episode?
Mood must be predominantly elevated, expansive or irritable, and definitely abnormal for the individual concerned.
Mood change must be prominent and sustained for at least 1 week (or severe enough to require hospitalisation)
List the ICD-10 criteria for part B in diagnosing a manic episode:
At least three of the following:
- Increased activity / restlessness
- Flight of ideas
- Pressure of speech
- Loss of social inhibitions
- Decreased need for sleep
- Inflated self esteem/grandiosity
- Distractibility or constant changes in plans
- Foolhardy / reckless behaviour
- Marked sexual energy
What is the ICD-10 part A criteria for hypomanic episode?
The mood is elevated or irritable to a degree which is abnormal for the patient and is sustained for least 4 consecutive days
What are the ICD-10 part B criteria for a hypomanic episode?
Must have at least 3:
- Increased activity /restlessness
- Pressure of speech
- Difficulty concentrating or distractibility
- decreased need for sleep
- Increased sexual energy
- Mild spending spree/reckless behaviour
Define mania without psychotic symptoms:
ICD-10 F30.1
The absence of hallucinations of delusions although there may be perceptual disorders e.g. vivid colour appreciation etc
Symptoms of clear mania are present
Define mania with psychotic symptoms:
ICD 10 F30.2
Delusions or hallucinations are present other than the typical schizophrenic one
Commonest example = grandiose, erotic or persecutory
Along side signs of mania
What is the lifetime prevalence of bipolar disorder?
1-4%
What age does bipolar disorder typically present?
Late teens / early 20s
approx. 10 years earlier than unipolar depression
What can lead to an earlier onset of bipolar affective disorder (BPAD)
Family history
Onset of bipolar disorder after the age of ___ is rare?
60
List some common comorbidities in bipolar affective disorder:
Anxiety disorders Alcohol / drug misuse Eating disorders Personality disorders Schizophrenia Schizoaffective disorder
What is the DSM criteria for Bipolar 1?
Must meet criteria for mania
Potentially past episodes of hypomania
Represents classic form of manic-depressive psychosis
What is the DSM criteria for Bipolar 2?
Current of part hypomanic episode & current / past depressive episode
Has never met criteria for manic episode (more common form of the illness)
List some differential diagnosis for Bipolar Disorder:
- Substance misuse
- ADHD
- Personality disorders
- Schizoaffective disorder
- Endocrine disturbances leading to mood abnormalities e.g. cushing’s
List some risk factors contributing to Bipolar Affective Disorder:
Family history +ve Childhood abuse Sleep disturbance Early post-partum "secondary mania" due to severe physical illness e.g. stroke
What is the rate of suicide in patients with BPAD?
10%
Define cyclothymia disorder:
Chronic mood fluctuations over at least two years with episodes of depression and hypomania (not mania) of insufficient severity to diagnose BPAD
BPAD affects males / females more?
Females
1.5 : 1
What is medications are used to manage an acute manic episode?
Atypical Anti-psychotics e.g. olanzapine
Benzodiazepines for rapid tranquilisation
Lithium (if not pregnant)
What is significant about lithium treatment in acute episodes of mania?
It takes longer as it has a slower onset of action so may not be as useful as an atypical antipsychotic
What medication is given prophylactic for BPAD?
Anti-manic Drugs e.g. lithium, carbamazepine, valproate and lamotrigine
Atypical Antipsychotics
What must you be aware of in patients with BPAD on anti-depressants?
Anti depressant therapy can lead to induction of manic episode so they should not be on anti-depressants long term
Lithium therapy in BPAD decreases the risk of ____
Suicide
___% of patients will suffer from recurrences of manic or depressive episodes
90%
A minority will develop _____ _____ which has a poor prognosis and seldom responds to lithium:
Rapid cycling
Rapid cycling patients will respond to ________ as a treatment instead of lithium.
Atypical Anti-psychotics
Patients on lithium must have what?
Regular blood levels monitored
What atypical antipsychotics can be used in BPAD/acute mania?
Olanzapine
Risperidone
Aripiprazole
Quetiapine
Approx. ___% of patients with cyclothymia will develop full blown BPAD?
30%
What benzodiazepine is commonly used for tranquilising during a manic episode?
Lorazepam
