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C. Year 3 MLA Neurology/Behaviour Conditions/Diseases > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

What are affective disorders?

A
  • disorders that affect the way you think and feel
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2
Q

In affective disorders terminology what does euthymia mean?

1 - bad mood
2 - upset
3 - angry
4 - normal mood

A

4 - normal mood

- greek for happy and well

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3
Q

In affective disorders terminology what are the 3 disorders of mood we need to be aware of that have a pervasive (an unwelcome influence on our mood or physical effect) that can affect their friends, family etc..?

1 - depression, hypomania, mania
2 - depression, euthymia, mania
3 - depression, hypomania, euthymia
4 - euthymia, hypomania, mania

A

1 - depression, hypomania, mania

  • Depression (low mood)
  • Hypomania (elevation of mood)
  • Mania (further elevation of mood)
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4
Q

In affective disorders terminology Depression, Hypomania and Mania are all disorders of mood that have a pervasive (an unwelcome influence on our mood or physical effect) affect that can affect their friends, family etc. What is common in patients with mood disorders such as these?

1 - free from other illness
2 - co-morbid physical disorders
3 - co-morbid psychological disorders
4 - co-morbid physical and psychological disorders

A

4 - co-morbid physical and psychological disorders

- metabolic syndrome and anxiety for example

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5
Q

What are subsyndromal mood disorders?

1 - mood disorders that are elevated above the diagnostic criteria, such as depression and mania
2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania

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6
Q

What is dysthymia?

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

1 - low mood (but not sufficient for diagnosis of depression)

  • greek for bad low mood
  • chronic low mood
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7
Q

What is Cyclothymia? (cyclo looks like cycling)

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis

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8
Q

In patients with depression (low mood) and hypomania (elevated mood) what other psychotic disorder can the symptoms present as?

1 - psychosis
2 - schizophrenia
3 - generalised anxiety disorder
4 - phobia

A

1 - psychosis

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9
Q

What is a key feature of bipolar disorder?

1 - period of high elation
2 - periods of high depression
3 - periods of high elation and depression
4 - periods of high elation and euthymia

A

3 - periods of high elation and depression

  • definition is >2 episodes of low mood (depression) and elevated mood (mania)
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10
Q

What is the key difference between bipolar disorder 1 and 2?

A
  • bipolar 1 can move across whole spectrum, such as severe psychotic depression and mania
  • bipolar 2 can move from psychotic depression to hypomania only
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11
Q

When comparing manic vs hypomanic, which has the longer presentation?

A
  • manic = at least 1 week long
  • hypomanic = several days
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12
Q

When comparing manic vs hypomanic, which has the following presentations?

1 - Elevated or irritable mood/expansiveness
2 - Increased energy
3 - Rapid/pressured speech
4 - Flight of ideas
5 - Increased self-esteem/grandiosity
6 - Decreased need for sleep
7 - Distractibility
8 - Impulsive/reckless behaviour

A
  • mania
  • hypomanic may have aspects of these, but generally less severe
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13
Q

When comparing manic vs hypomanic, do both have hallucinations and delusions?

A
  • no
  • just mania
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14
Q

What is the key aspect that determines mania from hypo or mild mania?

1 - volume of patient
2 - intensity of the patient
3 - functional impairment
4 - all of the above

A

3 - functional impairment

  • patient will also experience hallucinations and delusions
  • can involve high irritability, self important ideas, poor judgement and disinhibition
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15
Q

Bipolar disorders can be:

  • mixed = depressive and manic symptoms occur together
  • alternating = mania and depression follow one another, rapidly changing
  • rapid cycling = mania and depression follow each other, generally separated by a few weeks

Which of these has the highest suicide rates?

A
  • mixed states
  • depressive cognitions combined with manic energy are dangerous
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16
Q

In patients with bipolar disorder, do men or women liver longer?

A
  • women
  • patients die from suicide
  • women = live 13 years with 5% suicide
  • men = live 9 years with 8% suicide
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17
Q

All of the following are differentials for bipolar disorder, EXCEPT which one?

1 - schizophrenia
2 - dementia
3 - endocrine disorder
4 - delirium
5 - stimulant drugs

A

4 - delirium

  • not typically a differentials of bipolar disorder
18
Q

What is the 12 month prevalence of bipolar disorder?

1 - 0.6 - 0.8%
2 - 6 - 8%
3 - 16 - 38%
4 - 46 - 58%

A

1 - 0.6 - 0.8%

19
Q

What is the lifetime risk of developing bipolar disorder?

1 - 0.1%
2 - 1%
3 - 11%
4 - 21%

A

2 - 1%

  • no difference of risk in genders
20
Q

In patients diagnosed with bipolar disorders, what % are diagnosed before the age of 50 y/o?

1 - 0.9%
2 - 9%
3 - 39%
4 - 90%

A

4 - 90%

  • generally occur in 1st half of life
  • before 25 y/o and average is 18 y/o
21
Q

How long do bipolar episodes generally last for?

1 - 3 hours
2 - 3 days
3 - 3 weeks
4 - 3 months

A

4 - 3 months

  • it can vary, but this is the average
22
Q

What % of patients with bipolar disorder will attempt suicide at some point in their lifetime?

1 - 0.5%
2 - 5%
3 - 25%
4 - 50%

A

4 - 50%

  • 10% of those who attempt suicide will be successful
  • much higher risk than the general public
23
Q

What % of bipolar disorder has been attributed to genetics?

1 - 0.7%
2 - 7%
3 - 37%
4 - 70%

A

4 - 70%

24
Q

In a patient with bipolar disorder, what % of their lives is asymptomatic?

1 - 5%
2 - 20%
3 - 53%
4 - 93%

A

3 - 53%

25
Q

Why is a contralateral history important in bipolar disorder?

1 - more accurate than the patient
2 - patient may have no awareness of issue
3 - can often provide a diagnosis

A

2 - patient may have no awareness of issue

26
Q

What are the 2 phases of managing a bipolar patient?

1 - treat acute mood episode (depression or manic)
2 - maintenance outpatient appointments
3 - maintenance treatment for mood stability
4 - acute hospitalisation

A

1 - treat acute mood episode (depression or manic)

3 - maintenance treatment for mood stability

27
Q

Generally in a patient bipolar disorder who is having a manic episode, what class of medications should be stopped for fear of aggravating the episode?

1 - analgesis
2 - anti-depressants
3 - NSAIDs
4 - ACE-I

A

2 - anti-depressants

  • may need to slowly reduce rather than just stopping
28
Q

In a patient with an acute episode of mania, which drug class is the first line treatment?

1 - anti-depressants
2 - lithium
3 - atypical antipsychotic
4 - typical antipsychotic

A

3 - atypical antipsychotic

  • Olanzapine, Quetiapine or Risperidone are commonly tried 1st
  • core drugs are: Clozapine, Risperidone, Lurasidone, Olanzapine,Paliperidone, Quetiapine, Aripiprazole
29
Q

Why can benzodiazepines be useful in a patient who is experiencing an acute episode of mania?

1 - accentuates anti-psychotics
2 - reduces side effects of anti-psychotics
3 - promotes sleep and controls patients behaviour

A

3 - promotes sleep and controls patients behaviour

30
Q

The first line treatment for a patient with bipolar who is presenting with an acute episode of mania is an anti-psychotic drug. In addition, benzodiazepines be useful as adjunctive in treating the episode as it reduces brain activity through GABA, thus reducing neuronal activity and stimulation in the patient. However, once the patient is recovering, what is the maintenance treatment for bipolar disorder?

1 - diazepam
2 - zopiclone
3 - lithium
4 - aripiprazole

A

3 - lithium
- can take a several days to be effective

  • diazepam = benzodiazepines
  • zopiclone = Nonbenzodiazepines
  • aripiprazole = atypical anti-psychotic
31
Q

How does lithium work?

1 - increases re-uptake of serotonin
2 - increases re-uptake of noradrenaline
3 - inhibits Ca2+ release at pre-synapse
4 - all of the above

A

3 - inhibits Ca2+ release at pre-synapse

  • specifically inhibits IP3 re-synthesis, which is was triggers the Ca2+ release
32
Q

What other mood stabiliser can be prescribed to a patient who is experiencing an acute manic episode?

1 - sodium valprolate
2 - flumazenil
3 - zopiclone
4 - aripiprazole

A

1 - sodium valprolate

  • blocks Na+ channels
33
Q

Electroconvulsive therapy (ECT) involves sending electrical currents through the brain, similar to a seizure. Which of the following must occur before ECT is used in a patient with an acute manic episode?

1 - drugs are ineffective
2 - seriously disturbed patient
3 - risk to themselves or others
4 - all of the above

A

4 - all of the above

34
Q

What is the risk of a relapse in a patient with bipolar disorder in any year?

1 - 0.1 - 0.2%
2 - 1-2%
3 - 10-20%
4 - >50%

A

3 - 10-20%

35
Q

In a patient with bipolar disorder, what is the average number of episodes they will have in a 25 year follow up period?

1 - 1
2 - 10
3 - 30
4 - >50

A

2 - 10

Average 10 episodes over 25-year follow up

36
Q

In a patient with bipolar disorder, do they have more manic or depressive episodes?

A
  • depressive
37
Q

Which of the following is a form of non-pharmacological therapy that can be used in patients with bipolar disorder?

1 - CBT
2 - family therapy
3 - psychoeducation
4 - interpersonal therapy
5 - sleep hygiene
6 - all of the above

A

6 - all of the above

  • social service support is also very important
38
Q

When looking at preventing a relapse in a patient with bipolar disorder, what is the 1st line drug patients should be prescribed?

1 - anti-depressants
2 - lithium
3 - atypical antipsychotic
4 - typical antipsychotic

A

2 - lithium

  • reduces risk of relapse and suicide
  • can add sodium valprolate
  • lithium has a narrow therapeutic index so needs monitoring, renal especially)
39
Q

Why is mood monitoring important in patients with bipolar disorder?

1 - enhances communication with clinicians
2 - identifies early signs of relapse
3 - helps identify triggers of relapse
4 - all of the above

A

4 - all of the above

  • may also complete a depression and mania measure
40
Q

If a patient presents with an acute manic episode in later life, we need to investigate quickly. Why is this?

1 - acute mania is more dangerous in older patients
2 - can lead to increased suicide
3 - aetiology may be organic in nature
4 - all of the above

A

3 - aetiology may be organic in nature

  • basically it could be cause by illness or trauma

C. Year 3 MLA Neurology/Behaviour Conditions/Diseases (28 decks)

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