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2. General adult psychiatry > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

1
Q

Point prevalence of bipolar disorder

A

1.5%

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2
Q

Average age of onset of bipolar disorder

A

18-20

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3
Q

Increased risk of suicide among people with bipolar disorder compared to the general population

A

15-18x higher

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4
Q

Lifetime prevalence of bipolar I

A

1.0%

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5
Q

Lifetime prevalence of bipolar II

A

1.1%

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6
Q

Lifetime prevalence of subsyndromal bipolar spectrum

A

2.4%

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7
Q

Differences between bipolar I and bipolar II

A

Bipolar I has one or more manic or mixed episodes and typically has recurrent depressive episodes
Bipolar II must have at least one hypomanic episode and at least one depressive episode

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8
Q

Description of bipolar III

A

Recurrent depression with hypomania occurring only with antidepressants or other treatment

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9
Q

Percentage of patients with bipolar disorder who were previously misdiagnosed as having depression

A

40%

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10
Q

Stability of a bipolar diagnosis

A

70-91%

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11
Q

Average length of time to recover from a treated episode of mania

A

4-5 weeks

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12
Q

Percentage of patients with bipolar who show predominantly either depression or mania

A

56%

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13
Q

Of patients with bipolar who show polarity in their symtpoms, percentage who show mainly depressive symptoms

A

60%

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14
Q

Of patients with bipolar who show polarity in their symtpoms, percentage who show mainly manic symptoms

A

40%

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15
Q

Percentage of patients with bipolar who complete suicide

A

10-19%

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16
Q

Percentage of patients with bipolar who attempt suicide

A

25-35%

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17
Q

Percentage of suicide attempts in patients with bipolar which occur in the depressed phase

A

80%

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18
Q

Percentage of patients with bipolar who have a recurrence in the year following a mood episode

A

50%

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19
Q

Type of bipolar where patients experience more depressive symptoms

A

Bipolar II

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20
Q

Biggest predictor of relapse for patients with bipolar

A

Residual symptoms

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21
Q

Index mood disorder in bipolar that leads to patients spending less time unwell

A

Mania

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22
Q

Term for antidepressant induced mania

A

Switch

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23
Q

Term for when antidepressants over time increase the long-term frequency of manic episodes

A

Mood destabilisation

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24
Q

Percentage of patients with bipolar who show antidepressant switch

A

20-40%

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25
Q

Risk factors for antidepressant switch in patients with bipolar

A

Previous antidepressant induced mania
Bipolar family history
Exposure to multiple antidepressants
Initial illness beginning in adolescence or young adulthood

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26
Q

Features of bipolar depression compared to unipolar depression

A

Bipolar depression shows less anxiety, fewer physical complaints, hypersomnia, more withdrawal, and more atypical symptoms

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27
Q

Definition of rapid cycling bipolar disorder

A

4 or more episodes within a year

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28
Q

Definition of ultra-rapid cycling bipolar disorder

A

4 or more episodes within a month

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29
Q

Definition of ultra-ultra-rapid cycling bipolar disorder

A

Switches within one day on four or more days per week

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30
Q

Percentage of patients with bipolar who are rapid cyclers

A

20%

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31
Q

Percentage of patients with rapid cycling bipolar disorder who are women

A

80%

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32
Q

Clinical features of rapid cycling compared to standard bipolar disorder

A

Earlier onset of illness in rapid cycling
More severe depression and mania in rapid cycling
Lower global functioning in rapid cycling

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33
Q

Risk factors for rapid cycling

A

Hypothyroidism
Poor response to lithium
Younger age of onset
Substance misuse

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34
Q

Most commonly prescribed medications associated with secondary mania

A

Corticosteroids
L-dopa

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35
Q

Number of days of symptoms required for a diagnosis of mania

A

7 days

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36
Q

Number of days of symptoms required for a diagnosis of hypomania

A

4 days

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37
Q

First line treatment in a first episode of mania

A

Antipsychotics - haloperidol, olanzapine, quetiapine, or risperidone

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38
Q

Treatment for a first episode of mania if the patient is on antidepressants

A

Consider stopping the antidepressant
Treat with an antipsychotic regardless of whether the antidepressant is stopped

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39
Q

First line treatment in an episode of mania where the patient is known to have bipolar and is already on a mood stabiliser

A

Increase the dose of the mood stabiliser

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40
Q

Treatment options in an episode of mania where the patient is known to have bipolar

A

Increase the dose of the mood stabiliser (first line)
Augment the mood stabiliser with an antipsychotic if taking lithium or valproate
If already taking an antipsychotic - augment with lithium or valproate
ECT

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41
Q

When to consider ECT in an episode of mania where the patient is known to have bipolar

A

Severely unwell patients
Treatment-resistant mania
Patient preference
Pregnant women

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42
Q

Psychotropic with the highest risk of hyponatraemia

A

Carbamazepine

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43
Q

First line treatments for bipolar depression

A

Psychological intervention
Fluoxetine combined with lithium
Quetiapine monotherapy

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44
Q

Second line medication for bipolar depression

A

Lamotrigine - can be used in combination or as monotherapy

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45
Q

NICE recommendations for when to use long term maintenance management for patients with bipolar

A

After a manic episode with significant risk or adverse consequences
Bipolar I when there have been two manic episodes
Bipolar II when there is significant functional impairment or risk

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46
Q

First line treatment for long term maintenance of bipolar disorder

A

Lithium

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47
Q

Benefits of lithium therapy in bipolar disorder

A

Prevents manic and depressive relapse - more effective in preventing mania
Reduces risk of suicide

48
Q

Mood stabilisers which are more effective against manic than depressive episodes

A

Lithium
Valproate

49
Q

Mood stabilisers which are more effective against depressive than manic episodes

A

Lamotrigine

50
Q

Antipsychotics which can be used as maintenance therapy in bipolar disorder

A

Olanzapine
Quetiapine

51
Q

Treatment options for mixed episodes in bipolar disorder

A

Should be treated as manic episodes

52
Q

Mood stabiliser with the best evidence for mixed episodes

A

Valproate

53
Q

Treatment for rapid cycling bipolar

A

Treat hypothyroidism and substance misuse if present
Discontinue antidepressants
Consider lithium, valproate, and lamotrigine

54
Q

Number of years maintenance therapy should be continued for patients with bipolar disorder

A

At least 2 years
At least 5 years if the patient has risk factors for relapse

55
Q

Antidepressant class with the highest risk of causing a switch

A

TCAs

56
Q

Length of time antidepressants should be continued in bipolar depression

A

3-4 months

57
Q

Triad of symptoms seen in antidepressant associated chronic irritable dysphoria in patients with bipolar disorder

A

Irritability
Middle of the night insomnia
Dysphoria

58
Q

Antiepileptics with no use for treatment of mania

A

Vigabatrin
Topiramate
Phenytoin

59
Q

Side effects of vigabatrin

A

Psychosis
Visual field defects

60
Q

Visual side effects of topiramate

A

Diplopia
Acute myopia
Angle closure glaucoma

61
Q

Benzodiazepine with the best evidence base for use in acute mania

A

Clonazepam

62
Q

Most effective medication to reduce suicidality in patients with bipolar disorder

A

Lithium

63
Q

Percentage of patients diagnosed with depression who convert to a diagnosis of bipolar each year

A

0.3-4%

64
Q

Percentage of patients diagnosed with depression who convert to a diagnosis of bipolar within five years

A

8-14%

65
Q

Best intervention for acute lithium toxicity with neurological features

A

Haemodialysis

66
Q

Percentage of middle aged women taking lithium who experience hypothyroidism

A

20%

67
Q

Percentage of people taking lithium who develop a tremor

A

25%

68
Q

Frequency of dosing of lithium with the highest risk of polyuria

A

Twice daily dosing

69
Q

Parathyroid issue rarely caused by lithium

A

Hyperparathyroidism

70
Q

Evidence based psychotherapies for bipolar disorder

A

Family therapy
CBT
Psychoeducation
Interpersonal and social rhythms therapy

71
Q

Mood stabiliser which interferes with oral contraceptives

A

Carbamazepine

72
Q

Male:female ratio for bipolar I

A

1:1

73
Q

Male:female ratio for bipolar II

A

1:1.3

74
Q

Mood stabiliser most likely to cause thrombocytopaenia

A

Sodium valproate

75
Q

Initial treatment options for maintenance therapy in bipolar disorder

A

Lithium
Valproate
Olanzapine
Quetiapine

76
Q

First line mood stabiliser in hepatic impairment

A

Lithium

77
Q

Mood stabilisers contraindicated in severe hepatic impairment

A

Sodium valproate
Gabapentin

78
Q

Mood stabiliser relatively contraindicated in renal impairment

A

Lithium

79
Q

Interaction between aminophylline and lithium

A

Lithium levels reduced

80
Q

Mood stabiliser which can exacerbate psoriasis

A

Lithium

81
Q

Sex more likely to experience mixed affective states in bipolar disorder

A

Women

82
Q

Percentage of patients who have had a single manic episode who go on to have recurrent mood episodes

A

90%

83
Q

Features of cyclothymic disorder

A

Multiple mood episodes over a period of two years
Both high and low moods
Episodes do not meet criteria for either depression or hypomania/mania

84
Q

Length of time a manic episode needs to last for

A

One week
Any duration if hospitalisation is required

85
Q

Length of time a hypomanic episode needs to last for

A

4 days

86
Q

Number of additional symptoms required for a diagnosis of a manic episode as well as mood

A

3
4 if the mood is irritable rather than elevated

87
Q

Additional symptoms which suggest an episode of mania

A

Grandiosity
Flight of ideas
Decreased sleep
Increased talking
Distractability
Increase in goal directed activity
Psychomotor agitation
Involvement in activities with potential for painful consequences

88
Q

Interaction between sodium valproate and lamotrigine

A

Valproate increases lamotrigine levels >2x

89
Q

Interaction between oral contraceptive and lamotrigine

A

Oral contraceptive decreases lamotrigine levels by half

90
Q

Rate of serious rash related to lamotrigine therapy

A

0.08-0.13%

91
Q

Length of time over which lithium therapy should be stopped

A

One month

92
Q

Klerman’s bipolar subtype I

A

Mania with depression

93
Q

Klerman’s bipolar subtype II

A

Hypomania with depression

94
Q

Klerman’s bipolar subtype III

A

Cyclothymia

95
Q

Klerman’s bipolar subtype IV

A

Antidepressant induced mania or hypomania

96
Q

Klerman’s bipolar subtype V

A

Depression in a patient with a family history of bipolar disorder

97
Q

Klerman’s bipolar subtype VI

A

Mania without depression

98
Q

Frequency lithium levels should be monitored in a healthy patient established and stable on therapy

A

Every 6 months

99
Q

Patient groups who should have lithium levels monitored every three months

A

Older patients
Impaired renal function
Impaired thyroid function
Raised calcium levels
Poor control or adherence
Last level >0.8
Taking NSAIDs

100
Q

Frequency with which TFTs should be checked for a patient on lithium

A

Six monthly

101
Q

Uses for lithium

A

Acute treatment in mania
Prophylactic treatment in bipolar disorder
Augmentation in depression
Aggressive and self mutilating behaviour
Steroid induced psychosis
To raise WCC in patients on clozapine

102
Q

Investigations which should be done before lithium is commenced

A

U&Es
ECG
TFTs
FBC
BMI

103
Q

Timing of lithium medication preferred

A

Once daily at night

104
Q

Optimum level for lithium when used in acute mania for a young, healthy patient

A

0.8-1mmol/L

105
Q

Treatment best tolerated in patients with acute mania

A

Olanzapine

106
Q

Eye sign in severe lithium toxicity

A

Downbeat nystagmus

107
Q

ECG changes seen in lithium toxicity

A

T wave flattening
Prolonged QTc

108
Q

Mood stabiliser which causes bleeding gums

A

Carbamazepine

109
Q

Interactions between lithium and ECT

A

Increased risk of delirium
Prolonged seizures
Toxic lithium levels
Prolonged neuromuscular blockade

110
Q

First line treatment for long term maintenance of bipolar disorder in renal impairment

A

Sodium valproate

111
Q

Length of time a driving license should be suspended after one episode of mania

A

3 months

112
Q

Length of time a driving license should be suspended after an episode of mania, if the patient has had 4 or more episodes in the past year

A

6 months

113
Q

Anti epileptic drug which can lower transaminases

A

Vigabtrin

114
Q

Condition most associated with reverse neurovegetative symptoms

A

Bipolar depression

115
Q

Examples of reverse neurovegetative symptoms

A

Hyperphagia
Hypersomnia

2. General adult psychiatry (9 decks)

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