Bipolar Disorder Flashcards
What is bipolar disorder?
Disorder where patient suffers from both bouts of depression or mania
How many classifications of bipolar disorder?
2 classifications
What is bipolar I?
- Have to have had manic episode that meets full manic criteria
- Patients may have had other episodes that are hypomanic or depressive too
^This describes the classic manic-depressive psychosis
What is bipolar II?
- Person has had a current or past hypomanic episode but has never met criteria for manic episode
- They will also suffer from depressive episodes (most common form of bipolar)
- Not a milder form of disease
Depression vs bipolar?
- Single episode of hypomania or mania is bipolar episode (even if patient hasn’t had depressive episode)
- First episode of hypomania or mania on a background of recurrent depression means that it’s bipolar and not depression anymore
What is hypomania?
Level of disturbance below mania
Hypomanic episode criteria?
-Mood is definitely elevated or irritable to a degree that is definitely abnormal for individual and sustained for >4 consecutive days
+
-At least 3 of the following signs must be present
-Increased activity or physical restlessness
-Increased talkativeness
-Concentration difficulties
-Decreased need for sleep
-Increased sexual energy
-Mild spending sprees
-Reckless/irresponsible behaviour
Signs involved in hypomania criteria?
- Increased activity or physical restlessness
- Increased talkativeness
- Difficulty in concentration or distractibility
- Decreased need for sleep
- Increased sexual energy
- Mild spending sprees or other reckless/irresponsible behaviour
Manic episode criteria?
Mood must be predominantly elevated, expansive or irritable and definitely abnormal for individual
-Mood change must be prominent for at least a week
\+ At least 3 of the following signs: - ^Activity or physical restlessness -^ talkativeness>pressure speech -Flight of ideas/racing thoughts -Loss of normal social inhibitions -Decreased need for sleep -Inflated self esteem/grandiosity -Distractibility -Reckless behaviour -Marked sexual energy
Epidemiology of Bipolar Disorder?
- Equally common in men and women
- Mean age of onset = 21 (earlier than unipolar depression)
Clinical course of bipolar disorder?
- Typically about 50% of time with syndromal mood disturbance
- In 1&2 depression is most common
- Bipolar I = slightly higher levels of mania/hypomania
- Sub-syndromal symptoms= symptoms that don’t meet criteria for a depressive or manic episode are v common which is distressing/disabling
Acute management of mania?
- Discontinue antidepressant
- If already taking lithium, valproate or another mood stabiliser prophylactically consider checking levels + potentially increasing dose
- If patient not on antipsychotic or mood stabiliser maybe offer haloperidol, olanzapine, risperidone or quetiapine
If person is not taking an anti-psychotic or mood stabiliser in acute mania what should be offered?
- Haloperidol
- Olanzapine
- Quetiapine
- Risperidone
Management of acute bipolar depression?
- Antidepressants should not be prescribed without an antimanic drug
- Avoid antidepressants in those who are recently manic/hypomanic OR history of rapid cycling
- SSRIs (fluoxetine) referable to other classes
- Antipsychotics can be used alongside antidepressants
Maintenance therapy of bipolar disorder?
LITHIUM = gold standard
Other drugs:
-Lamotrigine or valproate
-Psychoeducation also important
Side effects of lithium?
Dry mouth Strange taste Weight gain Polydipsia Polyuria Tremor Hypothyroidism Long term reduced renal function Nephrogenic diabetes insipidus
Toxic effects of lithium?
- Vomiting
- Diarrhoea
- Ataxia
- Coarse tremor
- Drowsiness/altered consciousness
- Convulsions
- Coma
What does lithium require and why?
ALOT of monitoring
Due to toxicity
Examples of anticonvulsants used as mood stabilisers?
Valproate
Lamotrigine
Carbamazepine
MOA of anticonvulsants?
Very unclear
Which of lamotrigine, valproate and carbamazepine is teratogenic?
Valproate `
What doe lamotrigine carry a small risk of?
Steven Johnson syndrome
What side effects can valproate and carbamazepine have?
Drowsiness
Ataxia
Cardiovascular effects
Induction of liver enzymes
