Bipolar Disorder Flashcards
What are the potential factors for Bipolar Disorder?
Genetic factors, environmental factors, biochemical factors, endocrine factors, physical illness or side effects of medication
What is Bipolar 1?
Where people have severe manic episodes (often interspersed with episodes of major depression).
Mania last one week
What is Bipolar 2?
Where people experience depressive episodes and less severe manic symptoms - classed as hypomanic episodes
What are features of a manic episode?
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative / pressure to keep talking
- Racing thoughts
- Distracted
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
What are features of depressive episode?
- Suicidal preoccupation
- Negative views
- Feeling of hopelessness
- Fatigue or low energy
- Low appetite
- Previous manic episodes
How is Bipolar I and II diagonised?
Bipolar I – At least seven consecutives days of severe mania
Bipolar II – At least four days of hypomania and at least one major depressive episode
What does NICE not recommend in primary care of Bipolar Disorder?
The use of questionnaires
When should a patient be referred to specialist care from primary care according to NICE?
- When the patient has had overactivity or disinhibited behaviour which has lasted for 4 days or more
- Suspected mania (urgent)
- Suspected severe depression
- When the patient is a danger to themselves or others (urgent)
Which is the typical medication for Bipolar Disorder?
Haloperidol
When should a patient be referred to secondary care according to NICE?
- Poor or partial response to treatment
- Person’s functioning decline significantly
- Treatment adherence is poor
- Side-effects developed from medications
- Comorbid alcohol n drug misuse suspected
- Person considering stopping medication after a period of relatively stable mood
- Woman with bipolar disorder is pregnant or planning pregnancy
What most happen when patients start taking Lithium?
Regular blood test for Lithium levels
- Initally once a week
- Then can go to once a month or 6 weeks.
What are the therapies available in secondary care for Bipolar Disorder?
- A psychological intervention
- High-intensity therapy such as cognitive behavioural therapy, interpersonal therapy or behavioural couples therapy
What are the main groups of medications used in mania and hypomania - give examples of them?
Antipsychotics such as haloperidol, olanzapine, risperidone and quetiapine
Lithium
Antiepileptics such as Valproate
Which medications cannot be initiated in primary care for the management of mania and hypomania?
Lithium cannot be initiated in primary care, in patients that have never taken it before, unless there are shared care arrangements in place
Valproate cannot be initiated in primary care
Should a patient with mania or hypomania be given antidepressants?
Ideally no.
If already taking it, it should be considered to stop the antidepressant.
If taking antidepressants in combination with a mood stabiliser, consider stopping the antidepressant too.