Bipolar disorder Flashcards
Symptoms of mania
Abnormally elevated mood Extreme irritability Aggression Increased energy Pressure of speech Flight of ideas Psychotic symptoms
What does a diagnosis of a manic episode require
Requires symptoms of mania lasting for at least 7 days which usually begin abruptly
Symptoms of hypomania
Mild elevation of mood, irritability
Increased energy
Feelings of well-being, or physical and mental efficiency
Increased sociability
Hypomania vs mania
Hypomania is suggested by symptoms of mania that are not severe enough to cause marked impairment in social or occupational functioning, and the absence of psychotic features
What suggests a mixed episode
Mixture, or rapid alternation(usually within a few hours), of manic/hypomanic and depressive symptoms
Symptoms and signs that may help distinguish bipolar disorder from unipolar depression
Hypersomnia, lability and weight instability
Earlier age of onset
More frequent episodes of shorter duration
Co-morbid substance misuse
Higher post-partum risk
Psychosis
Lower likelihood of somatic symptoms
What are the minimum diagnostic criteria for bipolar disorder in children and young people
Mania must be present
Euphoria must be present on most days and for most of the time, for at least 7 days
Irritability is not a core diagnostic criterion
Age limit for referral of children to CAMHS
Children aged under 14 years of age
Young people aged 14-18 years may be referred to a specialist early intervention in psychosis service or to a CAMHS team
Which factors suggest cyclothymia as opposed to depression or bipolar disorder
Suggested by chronic disturbance of mood, consisting of periods of depression and hypomania, where the depressive symptoms do not meet the criteria for a depressive episode
Most common comorbidities in people with bipolar disorder
Anxiety disorders
Alchol and substance misuse
Assessment of bipolar disorder in primary care
Refer to a specialist mental health service
Determine risks of harm to others and self
How can you determine the risks of harm to others
Assess:
Risk of neglect of people dependent on them for care, in particular family, children, and any other dependents(follow local safeguarding procedures)
Any risk to the public, especially if there is a risk of aggression or previous history of violence
When should an urgent referral to a mental health service be made
Mania
Severe depression
Danger to themselves or other people
Risk of exploitation or violence
What can be done for a person with bipolar disorder in primary care while awaiting specialist assessment
Do not start antipsychotic medication unless on the advice from a consultant psychiatrist
Consider tapering antidepressant medication on specialist advice if mania develops
Advise person to stop driving during acute illness
What should be screened for in children presenting with symptoms of bipolar disorder
Assess for abuse
Useful support links for people with bipolar disorder
Bipolar UK
MIND
Base-uk(for people wanting to return to work)
DVLA
If a person with bipolar disorder is being managed solely in primary care, when should they be re-referred to secondary care
Poor or partial response to treatment
Significant decline in person’s functioning
Development of intolerance or side effects of medication
Comorbid alcohol or drug misuse
Pregnancy
Treatment of acute mania in secondary care
Oral antipsychotic(haloperidol, olanzapine)
Second antipsychotic if above not effective
Lithium as third line or sodium valproate if lithium not suitable
Antidepressant medication is usually tapered and discontinued if person develops mania
How are mixed episodes treated in secondary care
Usually treated in the same way as episodes of mania
Options for treatment of depression in secondary care
Quetiapine alone
Fluoxetine + olanzapine
Olanzapine alone
Lamotrigine alone
Management of mania after acute episode has resolved
Continue current treatment for mania, or
Start long-term treatment with lithium to prevent relapses or,
Sodium valproate addition to lithium
Psychological therapies
What actions will secondary care undertake for long term management of an individual with bipolar disorder
Monitor physical, mental health and effects of meds for at least first 12 months
Encourage person to make a lasting power of attorney
Write a care plan with the person and/or their carer that defines roles of primary and secondary care
Why should a person with bipolar disorder be advised to make a lasting power of attorney
So that a trusted person or an advocate can express the person’s point of view as expressed in the advanced statement or statement of wishes and feelings, especially if there are financial consequences resulting from mania or hypomania episodes
What should a care plan consist of
Individualised social and emotional recovery goals
Assessment of person’s mental state
Medication plan
Advance statement
Statement of wishes and feelings regarding treatment in future
Key clinical contacts in emergencies
What is an advance statement
A written statement, drawn up and signed when the person is well, which sets out there are treatments that the person does not wish to receive if they lose their capacity to make decisions for themselves through illness
What routine health reviews are required for people with bipolar disorder
For adults being managed in primary care, assess person’s mental and physical health at least annually
When should an individual with bipolar disorder be reviewed more regularly
If the person of their carer expresses any concerns
If there is sleep disturbance
After significant life events, such as loss of a job or bereavement
What advice should be given regarding prevention of a relapse
Encourage compliance with treatment Sleep advice Avoidance of shift work, night flying and across time zones Regular routine in morning Self-monitoring of symptoms Avoidance of caffeinated drinks Avoidance of alcohol, drugs and smoking
What is bipolar disorder type I
presents with manic episodes (most commonly interspersed with major depressive episodes). The manic episodes are severe and result in impaired functioning and frequent hospital admissions.
What is bipolar disorder type II
patients do not meet the criteria for full mania and are described as hypomanic. Hypomania in comparison to mania has no psychotic symptoms and results in less associated dysfunction. This type is often interspersed with depressive episodes.
ICD-10 requirement for diagnosis of bipolar disorder
At least two episodes in which a person’s mood and activity levels are significantly disturbed (one of which must be mania or hypomania)
Which side effect is lamotrigine commonly associated with
Rashes
