Bipolar disorder Flashcards
What are the risk factors for bipolar disorder?
First-degree relative (genetic)
Prenatal exposure to Toxoplasma gondii
Premature birth <32 weeks gestation
Cannabis use
Negative life events (circadian rhythm disruptions)
What are the features of bipolar I?
At least one episode of mania
Depression
Most common
What are the features of bipolar II?
At least one episode of hypomania but never an episode of mania
Major depression (at least one episode)
What are the characteristics of a manic episode (ICD-10)?
Elevated mood out of keeping with the pt’s circumstances
Elation + increased energy > overactivity, pressure of speech, decreased need for sleep
Inability to maintain attention
Grandiosity + increased confidence
Loss of normal social inhibitions
What characteristics are essential to provide a diagnosis of a manic episode?
Features of mania
For at least 7 days
Significant negative functional effect on work and social activities
Mood changes + increase in energy
What type of psychotic symptoms most commonly accompany a manic episode?
Delusions
Hallucinations (often auditory)
Psychotic symptoms are mood-congruent ie. grandiose in nature
Thought disorder may also be present
What are the characteristics of hypomania (ICD-10)
Persistent, mild elevation of mood
Increased energy and activity
Increased sociability, talkativeness, over-familiarity, increased sexual energy, decreased need for sleep
Irritability
Absence of psychotic features
What characteristics are essential to provide a diagnosis of a hypomanic episode?
More than one feature of hypomania
Present for at least 7 days
Functional impairment (lesser than seen in mania and not sev enough to cause impairment in occupational / social activities)
What are the differential diagnoses of bipolar disorder?
Schizophrenia
Organic brain disorder (frontal lobe pathologies)
Drug use (psychotropic drugs / steroids)
Recurrent depression
EUPD
Cyclothymia
What are the management options for an acute episode of mania?
Oral antipsychotics
Tapered / discontinued antidepressants (if already prescribed)
Benzodiazepines (manage symptoms of ^ activity / insomnia)
What are the management options for an acute episode of depression in bipolar disorder?
Fluoxetine + olanzapine, Quetiapine, Olanzapine, Lamotrigine
CBT
What are the oral antipsychotics used to treat an acute episode of mania?
Haloperidol
Olanzapine
Quetiapine
Risperidone
What are the long-term management options for bipolar disorder?
Mood stabilisers (e.g. lithium)
+ sodium valproate
CBT, interpersonal therapy, family-focussed therapies
What is an absolute contraindication for the use of sodium valproate for bipolar disorder?
Pregnancy (teratogenic effects)
Therefore, all women on sodium valproate must have a pregnancy prevention plan
What are the potential complications of bipolar disorder?
^ risk of death by suicide
^ risk of death by general medical conditions (e.g. CV disease)
SEs of antipsychotics
Socioeconomic effects
