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Y4 - Medicine - Psychiatry > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

DIAGNOSTIC CRITERIA

A
  • At least 2 episodes, one of which being mania/hypomania with recovery usually complete between episodes
  • Criteria for depressive episode same as usual depression criteria
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2
Q

DIAGNOSTIC CRITERIA

Mixed episode

A
  • Occurance of both manic/hypomanic and depressive symptoms in single episode, present every day for at least 2 weeks
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3
Q

PRESENTATION

Mixed episodes

A
  • Typical presentations include
    • Depression plus overactivity/pressure of speech
    • Mania plus agitation and reduced energy/libido
    • Dysphoria plus manic symptoms
    • Rapid cycling (fluctuating between mania and depression - 4 or more episodes/year)
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4
Q
A
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5
Q

ICD-10 CLASSIFICATION

Different classifications of episodes

A
  • Current episode, hypomanic
  • Current episode, manic without psychotic symptoms
  • Current episod, manic with psychotic symptoms
  • Current episode, mild or moderate depression
  • Current episode, severe depression without psychotic symptoms
  • Current episode, severe depression with psychotic symptoms
  • Current episode, mixed
  • Currently in remission
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6
Q

EPIDEMIOLOGY

Lifetime prevlalence

A

0.3-1.5%

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7
Q

EPIDEMIOLOGY

M:F

A

1:1

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8
Q

EPIDEMIOLOGY

Peak years

A

15-19 years and 20-24 years

Mean 21 years

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9
Q

PROGNOSIS

Morbidity and mortality

A
  • High in terms of lost work, lost productivity, effect on marriage and family
  • Attempted suicide 25-50%
  • Complete suicide 10%
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10
Q

DIFFERENTIAL DIAGNOSIS

A

Depends upon the nature of the presenting episode (mania/hypomania/depression)

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11
Q

PROGNOSIS

Re-occurence within 2 years of 1st episode

A

40-50% experience another manic episode

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12
Q

PROGNOSIS

Poor prognosis factors

A
  • Poor employment history
  • Alcohol abuse
  • Psychotic features
  • Depressive features between periods of mania and depression
  • Male sex
  • Treatment non-compliance
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13
Q

PROGNOSIS

Good prognostic factors

A
  • Manic episodes of short duration
  • Later age of onset
  • Few thoughts of suicide
  • Few psychotic symptoms
  • Few co-morbid physical problems
  • Good treatment response and compliance
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14
Q

AETIOLOGY

A
  • Genetic
  • ?Decreased activation and reduced grey matters in areas associated with emotional regulation
  • ?Increased activation in ventral limbic brain
  • ?Catechoramine hypothesis
  • Environmental factors
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15
Q

AETIOLOGY

Environmental factors

A
  • Stressful life events may lead to episodes
  • Pregnancy
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16
Q

AETIOLOGY

Cathecholamine hypothesis

A
  • Increase in epinephrine and norepinephrine causes mania
  • Whilst decrease causes depression
17
Q

MANAGEMENT

Acute episodes

A
  • Depends on nature of episode, may require hospitalisation
  • Consider issues of prophylaxis
18
Q

MANAGEMENT

Purpose of outpatient follow up

A
  • Monitor patients psychiatric status
  • Monitor medication side effects
  • Enhance treatment compliance
  • Provide education
  • Identifying new episodes early
19
Q

MANAGEMENT

Relapse prevention

A
  • Help patient identify precipients or early manifestations of illness
  • Promote normal sleeping pattern
  • Early signs of mania can be treated with short-term use of benzodiazepines or anitpsychotics
20
Q

MANAGEMENT

When to admit to hospital

A
  • High risk of suicide or homicide
  • Illness behaviour endangering relationships, reputation or assets
  • Lack of capacity to co-operate with treatment
  • Severe psychotic symptoms
  • Severe depressive symptoms
  • Severe mixed state
  • Catatonic symptoms
  • Failure of outpatient treatment
21
Q

MANAGEMENT

Specific clinical features that strongly influence choice of treatment

A
  • Psychotic symptoms
  • Catatonic symptoms
  • Risk of suicide
  • Risk of violence
  • Substance related disorders
22
Q

MANAGEMENT

Specific clinical features - psychotic symptoms

A

Lithium +/- antipsychotic

23
Q

MANAGEMENT

Specific clinical features - catatonic symptoms

A
  • Admit
  • Exclude medical problem
  • Treat with ECT and/or benzodiazepine
24
Q

MANAGEMENT

Specific clinical features - risk of suicide

A
  • Admit to hospital
  • Consider ECT
25
Q

MANAGEMENT

Specific clinical features - risk of violence

A
  • Assess risk
  • Admit to hospital and consider secure setting
26
Q

MANAGEMENT

Specific clinical features - substance related disorders

A
  • Address issued of misuse
  • If detoxification considered, admit to hospital as risk of suicide may be increased
27
Q

MANAGEMENT

Severe manic episode

A
  • ECT strongly considered as 1st line
28
Q

MANAGEMENT

Acute manic episode when not currently on treatment

A
  • Antipsychotic therapy 1st line
    • Second generation antipsychotics first line
  • Lithium or valproic acid 2nd line
29
Q

MANAGEMENT

Acute manic episode when on antidepressant medication already

A
  • Stop the antideppresant and commence antipsychotic
30
Q

MANAGEMENT

Depressive episode if already on prophylaxis

A
  • Consider adding SSRI if on antipsychotic
  • If not on antipsychotic consider quetiapine
31
Q

MANAGEMENT

Prophylactic treatment (lines)

A
  • 1st mood stabiliser and/or atypical antipsychotic
    • Plus psychosocial intervention
  • 2nd switch to or add alternative first line drug
    • Plus psychosocial intervention
  • 3rd alternative mood stabaliser and/or atypical antipsychotic
    • Plus psychosocial intervention/adjunct ECT

Y4 - Medicine - Psychiatry (27 decks)

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