bipolar and schizophrenia Flashcards
what is bipolar disorder?
serious long term mental illness usually characterised by episodic depressed and elated moods and increased activity (hypomania or mania)
what are the causes of bipolar disorder?
genetics - seems to run in families, (triggered by environmental factors)
chemical imbalances in brain of 1 or more neurotransmitters
what are the risk factors for bipolar disorder?
triggers inc:
- stress (rs, abuse, death of loved ones)
- physical illness
- sleep disturbance
- finance/work related problems
what are the symptoms of bipolar disorder? (4)
a) mania - abnormal, persistent high energy, cannot sleep/eat too much, can = hallucinations
b) hypomania - less intense mania, same symptoms but less than 4 days
c) depression - low mood, loss of interest, irritability, more than 2 weeks
d) mixed episode - alternate between mania and depression over few weeks
how is bipolar disorder diagnosed?
specialist mental health referral for diagnosis - dependent on symptoms and clinical judgement
what are the different types of bipolar disease?
bipolar I - at least one manic episode w/ or w/o history of major depressive episode
bipolar II - one or more major depressive episodes AND at least one hypomanic episode but no mania
what are the key patterns in bipolar disorder?
rapid cycling - repeated swings from high to low phases quickly
mixed state - symptoms of mania and depression together
–> both types of bipolar can present w these
what are the 4 evidence based treatments for bipolar disorder?
medication for prevention and Tx
lifestyle advice
psychological Tx
recognition of signs and triggers
what are the medication treatments? (3)
- antipsychotics
- lithium
- anticonvulsants
what antipsychotics are used?
olanzapine, haloperidol, quetiapine
what do you need to monitor w antipsychotics?
all bloods: lipids, HbA1C, toxicity indication
- prolactin concentration: risk of symptomatic prolactinaemia (i.e., breast enlargement)
–> patient must inform DVLA if on antipsychotics
haloperidol: lowest dose for elderly due to risk of neuro and cardiac effects
what is second line? what needs monitoring?
lithium
- patient must have had mania for 6 months before starting this
- renal, cardiac, thyroid function, ECG, BMI, serum electrolytes, FBC - special attention to calcium levels and thyroid function (can inhibit thyroid function = hypothyroidism)
- more frequent monitoring needed if issues with calcium, thyroid, or kidneys
- further details under monitoring in BNF
what is third line? what needs monitoring?
anticonvulsants
- lamotrigine, valproate (not in people under 55 unless 2 specialists agree), carbamazepine
- used as long term mood stabiliser or in conjunction w Li
- valproate considered if antipsychotic + Li does not work for mania
- w valproate, ensure pregnancy prevention programme in place for women of childbearing potential
- monitoring: baseline weight, FBC, LFT then 6 monthly
- lamotrigine should not be given to treat acute mania
what additional Tx can be added on if needed?
antidepressants; SSRIs in severe depression
can be used in conjunction w olanzapine
- NOT w/ Li though –> only added WITH olanzapine to Li if Pt at max Li dose
- interaction w valproate
- must inform DVLA if on these
what are factors to consider with medications?
regular blood tests for antipsychotics, Li, valproate
- fasting glucose, HbA1c
- lipid
- Us & Es
- FBC
- LFTs
- thyroid and calcium for Li
how can relapses be prevented?
- compliance w Tx
- adequate sleep
- avoidance of night shifts, working long hours
- regular morning routine
- activity & social contact
- avoiding caffeinated drinks
- avoiding smoking & alcohol + drug misuse
- self monitoring symptoms inc triggers and coping strategies
how is mental health and wellbeing related to bipolar disease?
isolation, financial crisis, stress at school/work exacerbates mental health issues
these are risk factors for bipolar
what is schizophrenia?
long term mental health condition which causes psychosis and is associated with considerable disability. can impact all areas of life inc occupational functioning.
psychosis = person cannot distinguish their own thoughts/ideas from reality
what are the symptoms of schizophrenia?
+ve and -ve
+ve:
hallucinations, delusions (unusual beliefs not reality based), muddled thoughts/speech
-ve:
losing interest in daily activities, neglecting own needs + personal hygiene, avoiding people, feeling disconnected from emotions
DOES NOT MEAN ONE IS VIOLENT/SPLIT PERSONALITY
what are the causes of schizophrenia?
genetic: difference in brain development (neurotransmitters play a role), pregnancy and birth complications (low birthweight, premature, lack of oxygen)
environmental: triggers inc stress or drug misuse
how is schizophrenia diagnosed?
no specific test
diagnosed by mental health specialist
what evidence based treatments are there? (2)
talking therapy
medications
what does the first treatment entail?
a) community mental health teams (social worker, occupational therapist, counsellors, psychologist) to determine Pt needs
b) CBT - identifying thinking patterns that = unwanted feelings
c) CPA (care programme approach) - assessing Pt needs and providing Tx with regular reviews
what does the second treatment entail?
antipsychotics:
typical - 1st gen; block D2 receptors in brain to disrupt dopaminergic neurotransmission
e.g., prochlorperazine, haloperidol
atypical - 2nd gen; acts on range of receptors, associated w fewer extrapyramidal symptoms
e.g., olanzapine, clozapine, risperidone, quetiapine
both are effective for +ve symptoms but 2nd gen are also effective for -ve symptoms
