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Sem 3, Case 8 (schizophrenia and Bipolar) > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

What are the 2 key elements of bipolar?

A

Depression
Mania/hypomania

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2
Q

What are the 2 main subtypes of bipolar disorder and how do they differ?

A
  1. Bipolar I (mania and depression alternate)
  2. Bipolar II (hypomania and depression, at least 1 episode of each)
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3
Q

What are hypomania episodes?

A
  • milder form of mania
  • don’t usually cause impairment
  • often improve productivity
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4
Q

What can Bipolar II often be mistaken for? Why?

A

MDD

usually patients present with depression and don’t see hypomania as severe/a problem
often depression becomes more predominant than hypomanic episodes over time

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5
Q

Difference between Mania and Hypomania?

A

Mania = causes impairment in functioning, decreasing productivity

Hypomania = doesn’t cause impairment, can increase productivity

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6
Q

How long is the time period of elevated/irritable mood necessary for a diagnosis of:
A) Mania ?
B) Hypomania ?

A

Mania = 1 week (most of the day, nearly everyday)

Hypomania = 4 consecutive days, at least (most of the day, nearly everyday)

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7
Q

What is the DSM-5 criteria for diagnosing mania/hypomania?

A

Over a week (M) /4days (HM), 3 or more of:

  • inflated sense of self (grandiosity)
  • decreased need for sleep
  • more talkative than normal (pressure of speech)
  • racing thoughts (flight of ideas)
  • high distractibility
  • acts in goal-oriented manner
  • excessive involvement in high risk pleasurable activities
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8
Q

What is the DSM-5 criteria for diagnosing mania?

A
  • 1 week of excessively high/irritable mood
  • 3 or more of the 7 symptoms
  • symptoms cause marked impairment or psychotic features
  • not attributable to substance misuse/other conditions
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9
Q

What is the DSM-5 criteria for diagnosing hypomania?

A
  • at least 4 consecutive days of excessively high/irritable mood
  • 3 or more of the 7 symptoms
  • the change is observable by others
  • doesn’t cause impairment, no psychosis features (that’s automatically mania)
  • not attributable to substance misuse/other conditions
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10
Q

Which gender is BP slightly more prevalent in?

A

Males

(1 : 1.1 // F:M)

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11
Q

What is the mean age of onset of:
A) BP I ?
B) BP II ?

A

Bipolar I = 18

Bipolar II = mid 20s

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12
Q

What is a differential diagnosis of first manic episode diagnosed in later life ?

A

Frontotemporal dementia

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13
Q

Is average life expectancy decreased in Bipolar patients?

A

Yes, by 9-20 years

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14
Q

Why is life expectancy decreased in BP patients?

A
  • increased risk of disease (cardiovascular, metabolic etc)
  • medication adverse effects
  • smoking
  • suicide
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15
Q

Can BP be cured?

A

It is a chronic, life-long condition for most
It can be treated not cured

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16
Q

What is the risk of suicide in BP patients compared to general population?

A

At least 15x higher in BP

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17
Q

What are some common co-morbidities of BP?

A

Anxiety
ADHD
Drug/substance misuse
Eating disorders
Migraine

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18
Q

Which type of BP disorder is more closely linked to eating disorders?

A

Bipolar II

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19
Q

What are the 2 aspects of the aetiology of bipolar disorder?

A

Environmental
Genetic

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20
Q

What are the contributing environmental causes of BP?

A
  • childhood trauma
  • stress and loss
  • seasonal changes (mania = warmer months, depression = colder)
  • medications (antidepressants can exacerbate mania)
  • medical disorders (MS, Epilepsy, hypothyroidism, CVD)
  • substance misuse
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21
Q

What are the contributing genetic causes of BP?

A
  • heritability >70%
  • 30 risk loci found

Genetics play the largest role in BP

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22
Q

Which factor is more causative in BP, environment or genetics ?

A

Genetics

23
Q

Which other condition is most strongly correlated with:
A) BP I ?
B) BP II ?

A

BP I = schizophrenia
BP II = MDD

24
Q

How many risk gene-loci have been found in relation to BP?

A

30

25
Q

What % of BP patients will likely experience psychosis in their lifetime?

A

50% (usually in manic episodes of BP I)

26
Q

What is the pathophysiology of bipolar disorder?

A

Not certain
Dysregulation of dopamine and serotonin systems

Mania with psychosis = increased dopamine in striatum (similar to schizophrenia)

27
Q

What is rapid cycling?

A

4+ episodes of mania or depression within a year

28
Q

What is the increase chance of having bipolar if a family member has it ?

A

10x more likely

29
Q

What are the 3 phases of BP that require treatment?

A

Acute Mania
Acute Depression
Maintenance phase (prophylaxis)

30
Q

What drugs are used to treat acute mania?

A

Lithium (mood stabiliser)
Antipsychotics (D2 antagonists)
Valproate (antiepileptic)
Carbamazepine (antiepileptic)

31
Q

Which of the mania-related drugs are least tolerable?

A

Lithium !

Antipsychotics are most tolerable followed by valproate and carbamazepine

32
Q

Which drugs are used to treat acute depression in bipolar?

A

Lithium
Low does quetiapine
Lamotrigine (anti-epileptic)

NOT ANTIDEPRESSANTS as increase rapid mood cycling/switching to mania

33
Q

If antidepressants are used in BP, what must they be used along side?

A

Antipsychotics and lithium

34
Q

Which drugs are useful as prophylactics in BP maintenance phase?

A

Lithium

Quetiapine or valproate if lithium isn’t viable

35
Q

Which of the antipsychotics are useful in BP phases other than manic episodes?

A

Quetiapine and olanzapine, the others are only effective in mania

36
Q

How is lithium eliminated from the body?

A

Renal (kidney) function

37
Q

Why do you need to do regular blood tests when prescribing lithium?

A

It has a narrow therapeutic window between being ineffective and toxic

38
Q

What is the ideal plasma level of lithium?

A

0.6-0.8 mmol/L (12hrs post-dose)

39
Q

What drugs are contraindicated when using lithium?

A

Any drugs that alter renal function, e.g
- ACE inhibitors
- NSAIDs
- thiazide diuretics

40
Q

What is lithium metabolism like?

A

Absorbs quickly
Isn’t metabolised
Is excreted unchanged, by kidney

41
Q

Which drug is effective across all 3 phases of BP?

A

Lithium

Better in mania than depression though

42
Q

Is CBT effective treatment during acute episodes of mania/depression in BP?

A

No, but can be effective after an episode

43
Q

What plasma level of lithium has a high risk of toxicity/side effects

A

Above 1.2 mmol/L

44
Q

What is the first line treatment for all 3 stages of BP?

A

Lithium (mood stabiliser)

45
Q

How much does lithium decrease risk of attempted/successful suicide in BP?

A

decreases risk by 80%

46
Q

What are the intended MOA effects of lithium?

A
  • INCREASES 5-HT and GABA transmission = inhibitory
  • DECREASES glutamate and dopamine = excitatory
47
Q

What are some side effects of lithium at a NORMAL dose?

A
  • fine hand tremors
  • mild GI upset
  • mild brain fog
  • weight gain
  • ankle oedema
48
Q

What are some signs of lithium toxicity ?

A
  • Anorexia
  • Nausea/vomiting
  • Diarrhoea
  • Muscle weakness
  • Course tremor
  • Drowsiness
49
Q

What drugs fall under the term valproate?

A
  • valproic acid
  • sodium valproate
  • valproate semisodium (Depakote = valproic acid + sodium valproate, 1:1)
50
Q

Which phases of BP indicate potential use of valproate?

A

Acute mania (3rd line, resistant mania)
Maintenance against mania (if lithium wasn’t successful)

51
Q

What is the MOA of valproate?

A

Increases GABA
Decreases neuronal excitability

52
Q

What are the adverse effects of valproate?

A

Very commmon:
- nausea
- tremor
- weight gain
- pregnancy complications (NTDs)

53
Q

What are some side effects in pregnancy associated with valproate?

A
  • NTDs (Spina Bifida)
  • malformation
  • polydactyly
  • limb reduction
  • atrial septal defects
54
Q

What effects can a mother taking valproate during pregnancy have on the development on the child?

A

Late walking
Late talking
Memory problems
Difficulty with speech and language
Lower IQ
Increased risk of autism by 3-5x

Sem 3, Case 8 (schizophrenia and Bipolar) (2 decks)

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