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
