Bipolar Disorder Flashcards
What is bipolar disorder?
A disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of hypomania or mania, and on others, depression
What is the aetiology of bipolar disorder?
80% of causes thought to have genetic component
Stressful life events
Sleep deprivation
Physical illness
What are the types of bipolar disorder?
Bipolar type 1
Bipolar type 2
Cyclothymia
Rapid cycing
What is bipolar type 1?
At least one episode of mania
May or may not have depression
What is bipolar type 2?
At least one episode of hypomania
At least one episode of depression
Which is more common, bipolar type 1 or 2?
Type 2
What is cyclothymia?
Chronic mood disturbance associated with numerous episodes of mild hypomania and depression
Episodes are either not long enough or severe enough to meet criteria for bipolar diagnosis
What is rapid cycling?
Four or more episodes of mood disturbance within a year
What is hypomania?
Less severe than mania
Mood is elevated or irritable to an abnormal degree for at least 4 days, causing some interference with interpersonal function
Persistent and non-reactive
What are the symptoms of hypomania?
At least 3 of:
- Increased activity or physical restlessness
- Increased talkativeness
- Difficulty in concentration or distractibility
- Decreased need for sleep
- Increased sexual energy
- Mild spending sprees or other types of reckless or irresponsible behaviour
What is mania?
Mood is predominately elevated, expansive or irritable to an abnormal degree for at least 1 week or to the extent that hospitalisation is required, causing severe interference with personal functioning
What are the symptoms of mania?
At least 3 of the following:
- Increased activity, restlessness
- Increased talkativeness
- Flights of ideas or thoughts racing
- Loss of normal social inhibitions
- Decreased need for sleep
- Inflated self esteem or grandiosity
- Distractibility or constant changes in activity or plans
- Reckless or risky behaviour in which the patient doesn’t see the risk
- Marked sexual energy or sexual indiscretion
- Psychosis
Describe appearance and behaviour in mania
Bright clothes
Distractibility
Loss of normal social inhibitions/overfamiliarity
Describe speech in mania
Increased talkativeness
Punning and clang associations
Describe thoughts in mania
Increased flow
Flight of ideas and loosening of associations
Grandiosity
What is mania with psychosis?
Mania when delusions or hallucinations are present
Hallucinations are completely impossible or culturally inappropriate
Different from schizophrenic hallucinations (not 3rd person, no running commentary)
Most common are grandiose, self-referential, erotic or persecutory
What is the management for an acute episode of mania?
First line: Olanzapine
Second line: Lamotrigine, valproate, lithium
Third line: ECT
What is the management for an acute episode of depression?
First line: Quetiapine
Second line: Lamotrigine, valproate, antidepressants
Third line: ECT
Why are antidepressants not first line for depression in bipolar disorder?
They have the potential to destabilise mood and cause mania
What is the pathway for maintenance therapy in bipolar disorder?
First line: lithium
Second line: anticonvulsants (lamotrigine, valproate) or antipsychotics (quetiapine)
Psychoeducation and other psychotherapy
When is lithium avoided?
First trimester of pregnancy
If compliance is an issue
What are the therapeutic and toxic levels of lithium?
Therapeutic: 0.4-1mmol/l
Toxic: >1.5mmol/l
What is required of patient on lithium?
Regular blood tests: lithium levels, U&Es, thyroid function tests
What are the side effects of lithium?
Fine tremor Dry mouth Metallic taste Weight gain Hypothyroidism QT prolongation Decline in renal function
What fetal disorder can lithium in the first trimester cause?
Epstein’s cardiac anomaly
What symptoms can lithium toxicity cause?
D&V
Course tremor, myoclonus
Restlessness, confusion and drowsiness, seizures
Electrolyte disturbances
Severe: Renal failure, arrhythmia , Coma, Death§
Which other drug for bipolar disorder should be avoided in pregnancy?
Valproate
