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Psychiatry > Bipolar Affective Disorder > Flashcards

Bipolar Affective Disorder Flashcards

1
Q

What is the first part (A)of the ICD-10 criteria for diagnosing a manic episode?

A

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)

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2
Q

List the ICD-10 criteria for part B in diagnosing a manic episode:

A

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
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3
Q

What is the ICD-10 part A criteria for hypomanic episode?

A

The mood is elevated or irritable to a degree which is abnormal for the patient and is sustained for least 4 consecutive days

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4
Q

What are the ICD-10 part B criteria for a hypomanic episode?

A

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
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5
Q

Define mania without psychotic symptoms:

A

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

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6
Q

Define mania with psychotic symptoms:

A

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

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7
Q

What is the lifetime prevalence of bipolar disorder?

A

1-4%

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8
Q

What age does bipolar disorder typically present?

A

Late teens / early 20s

approx. 10 years earlier than unipolar depression

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9
Q

What can lead to an earlier onset of bipolar affective disorder (BPAD)

A

Family history

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10
Q

Onset of bipolar disorder after the age of ___ is rare?

A

60

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11
Q

List some common comorbidities in bipolar affective disorder:

A 
Anxiety disorders
Alcohol / drug misuse
Eating disorders
Personality disorders
Schizophrenia
Schizoaffective disorder
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12
Q

What is the DSM criteria for Bipolar 1?

A

Must meet criteria for mania
Potentially past episodes of hypomania
Represents classic form of manic-depressive psychosis

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13
Q

What is the DSM criteria for Bipolar 2?

A

Current of part hypomanic episode & current / past depressive episode
Has never met criteria for manic episode (more common form of the illness)

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14
Q

List some differential diagnosis for Bipolar Disorder:

A
  • Substance misuse
  • ADHD
  • Personality disorders
  • Schizoaffective disorder
  • Endocrine disturbances leading to mood abnormalities e.g. cushing’s
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15
Q

List some risk factors contributing to Bipolar Affective Disorder:

A 
Family history +ve
Childhood abuse
Sleep disturbance
Early post-partum
"secondary mania" due to severe physical illness e.g. stroke
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16
Q

What is the rate of suicide in patients with BPAD?

A

10%

17
Q

Define cyclothymia disorder:

A

Chronic mood fluctuations over at least two years with episodes of depression and hypomania (not mania) of insufficient severity to diagnose BPAD

18
Q

BPAD affects males / females more?

A

Females

1.5 : 1

19
Q

What is medications are used to manage an acute manic episode?

A

Atypical Anti-psychotics e.g. olanzapine
Benzodiazepines for rapid tranquilisation
Lithium (if not pregnant)

20
Q

What is significant about lithium treatment in acute episodes of mania?

A

It takes longer as it has a slower onset of action so may not be as useful as an atypical antipsychotic

21
Q

What medication is given prophylactic for BPAD?

A

Anti-manic Drugs e.g. lithium, carbamazepine, valproate and lamotrigine
Atypical Antipsychotics

22
Q

What must you be aware of in patients with BPAD on anti-depressants?

A

Anti depressant therapy can lead to induction of manic episode so they should not be on anti-depressants long term

23
Q

Lithium therapy in BPAD decreases the risk of ____

A

Suicide

24
Q

___% of patients will suffer from recurrences of manic or depressive episodes

A

90%

25
Q

A minority will develop _____ _____ which has a poor prognosis and seldom responds to lithium:

A

Rapid cycling

26
Q

Rapid cycling patients will respond to ________ as a treatment instead of lithium.

A

Atypical Anti-psychotics

27
Q

Patients on lithium must have what?

A

Regular blood levels monitored

28
Q

What atypical antipsychotics can be used in BPAD/acute mania?

A

Olanzapine
Risperidone
Aripiprazole
Quetiapine

29
Q

Approx. ___% of patients with cyclothymia will develop full blown BPAD?

A

30%

30
Q

What benzodiazepine is commonly used for tranquilising during a manic episode?

A

Lorazepam

Psychiatry (15 decks)

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