Bipolar Affective Disorder Flashcards
How does the DSM break up Bipolar affective disorder?
By course and severity
DSM Bipolar Type 1
Meets the criteria for mania with previous episodes of hypomania and depression.
DSM Bipolar Type 2
Current of past hypomanic episode with a current or past depression, but never met criteria for mania
How does ICD10 divide Bipolar affective disorder?
Describes episode severity
What is the ICD 10 definition of Bipolar Affective Disorder?
Two or more episodes of either hypomania or mania alongside depression.
Hypomania
Level of disturbance below mania
Mood is abnormally elevated for the individual that last for four days
At least the symptoms that interfere with normal function.
What are the core symptoms of Hypomania?
Physical restlessness Talkativness Difficulty in concentration Increased sexual energy Mild spending sprees Reckless behaviour
Mania
Abnormally elevated and expansive mood for individual
Mood change is prominent and sustained for over a week.
Severe interference with life
What are the core symptoms of Mania?
Same as hypomania + Increased talkativeness Monologues Loss of social inhibitions Inflated self esteem Foolhardy reckless risk taking Marked sexual energy and indiscretion
How does someone with hypo/mania appear or behave?
Bright clothes
Distractabilty
Over familiarity
How does someone with hypo/mania speak?
Increased talkativeness
Difficult to get a word in
Punning and clanging associations
What is the form flow and content of a patients thoughts with hypo/mania?
Increased flow
Flight of ideas - loose associations
Ideas of grandiosity
Epidemiology of Bipolar Affective disorder
Late teens early 20’s
Family history can lead to earlier onset and increased severity
If an elderly patient presents with bipolar affective disorder what is usually the cause?
Organic cause
What are some comorbid conditions?
Anxiety Alcohol and drug misuse Personality disorders Eating disorders Schizoaffective disorders Schizophrenia
What are some predictors of poor outcome in a patient with Bipolar Affective disorder?
Early onset Low socioeconomic output Long duration Rapid mood fluctuations Psychosis Comorbid disorders
What is the gold standard treatment for Bipolar Affective Disorder?
Lithium Carbonate
What is the desired Lithium 12 hour post dose blood level ?
0.4 - 1.0
What other classes of drugs can be used in Bipolar Affective Disorder?
Anticonvulsants
Antipsychotic
What Anticonvulsants can be used in Bipolar Affective Disorder?
Valproic Acid
Lamotragine
Carbezamapine
What Antipsychotics can be used in Bipolar Affective Disorder?
Olanzapine
Aripiprazole
Quetiapine
What genetic mutation has a mild association with Bipolar Affective Disorder?
Short Allele of Serotonin Transporter Gene
If someone presents with Acute Mania what are the 1st line drugs?
Antipsychotics e.g.
Olanzapine
Quetiapine
Risperidone
What can be used alongside the antipsychotic drugs in the treatment of acute mania?
Lithium
Sodium Valproate
Carbamezapine
ECT
How should medication be administered in Acute Mania?
Orally
IM if non compliant need Mental Health Act
When are benzodiazepines used in acute mania?
To treat symptoms like extreme agitation
Short term use
When should antidepressants not be used in Bipolar Affective Disorder?
Recent history of mania
Or evidence or rapid cycling bipolar
What is the 1st line drug for acute Bipolar ?
Quetiapine - Antipsychotic
When can Antidepressants be used in Bipolar Affective disorder?
Alongside Lithium or Sodium Valproate
If primary complaint is depression in Bipolar
What Antidepressant is used in Bipolar Affective Disorder?
Lamotrigine - Slowly titrate
What must be monitored if patient is on long term maintenance Lithium?
U and Es
ECG
Calcium
