Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psych > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards
1
Q

What is bipolar disorder?

A

A chronic mental disorder with periods of mania/ hypomania alongside episodes of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the peak age incidence?

A

20-30 years, 1:1 sex ratio, first degree relatives 7x increased incidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of bipolar disorder?

A
  • Type 1: mania and depression (most common)
  • Type 2: hypomania and depression

If this is their first episode of mania/ hypomania, you can’t diagnose bipolar disorder - they need at least 2 episodes of mood disturbance for a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between mania and hypomania?

A
  • Mania: severe functional impairment or psychotic symptoms for 7 days or more (unless it’s severe enough for hospital admission)
  • Hypomania: decreased or increased function for 4 days or more

Psychotic symptoms such as delusions of grandeur or auditory hallucinations suggest mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When, in a primary care setting, should an urgent referral to CMHT for specialist mental health assessment be made?

A

If mania or severe depression is suspected, or the patient is a danger to themselves or others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What management should patients with bipolar depression be offered in primary care?

A
  • A psychological intervention developed specifically for bipolar disorder with a published evidence-based manual describing how it should be delivered or
  • A choice of psychological intervention (CBT, interpersonal therapy, behavioural couples therapy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is CBT?

A
  • Goal oriented and structured
  • Focuses on resolving current issues
  • Focuses on how thoughts, beliefs, attitudes, feelings and behaviour interact and teaches coping skills to deal with things in life differently
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should not be started in primary care?

A
  • Lithium for people who have not taken lithium before
  • Valproate (anti-convulsant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should patients be referred to the community mental health team (CMHT) if their bipolar disorder is managed solely in primary care?

A
  • Poor or partial response to treatment
  • Functioning declines significantly
  • Treatment adherence is poor
  • Person developes side effects from medication
  • Comorbid alcohol or drug misuse is suspected
  • Person is considering stopping medication after a period of relatively stable mood
  • Patient is pregnant or planning a pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How often should the physical health of patients with bipolar disorder be checked?

A

At least annually, focussing on:
- Cardiovascular health
- Diabetes
- Obesity
- Respiratory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What needs to be monitored in patients taking long term lithium?

A

Renal, thyroid function and calcium levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What risk assessment should be carried out for patients with bipolar disorder?

A
  • Self-neglect
  • Self-harm
  • Suicidal thoughts or intent
  • Risk to others
  • Driving
  • Spending money excessively
  • Financial or sexual exploitation
  • Disruption in family and love relationships
  • Disinhibited and sexualised behaviour
  • Risks of STIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is mania or hypomania managed in a patient taking antidepressants?

A
  • Consider stopping the antidepressant
  • Offer antipsychotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What pharmacological inteventions should be offered in an acute episode (or first presentation) of mania/ hypomania?

A

Prescribe an antipsychotic
First line antipsychotics:
- Olanzapine
- Quetiapine
Alternative antipsychotics:
- Risperidone
- Haloperidol

Often with an adjunctive benzodiazapine

If the patient’s on an antidepressant, stop and/or add an antipsychotic

If the patient’s already taking a mood stabiliser, optimise the dose and add an antipsychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management if the patient doesn’t tolerate the first line antipsychotic and an alternative isn’t effective at the maximum dose?

A

Consider adding a mood stabiliser like lithium, however these are rarely used in the acute setting as the patient needs to give consent and doses are titrated up slowly

It tends to be the prolonged management for BPAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the management if the patient doesn’t tolerate the first line antipsychotic, an alternative isn’t effective at the maximum dose and adding lithium is ineffective?

A

Consider adding valproate (anti-convulsant) instead (same guidance applies as with lithium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the guidance for offering valproate to fertile people of childbearing potential?

A

Only used in these patients if there’s no affective alternative
- Must have a second opinion from another doctor (at least 2 opinions to prescribe)
- The patient and doctors have to sign that the patient is aware they must use 2 forms of contraception whilst taking the medication

18
Q

If someone with a BPAD diagnosis is taking lithium long-term and developes mania, what are the next steps?

A
  • Check plasma lithium levels to optimise treatment
  • Consider adding olanzepine or quetiapine (or one of the alternatives) depending on preference and response to treatment
19
Q

What should be done if a woman or girl of childbearing potential is taking valproate?

A

Advise to gradually stop the drug due to risk of fetal malformations and adverse neurodevelopmental outcomes after any exposure in pregnancy

If the drug is continued, they should be prescribed a folate supplement

20
Q

What should not/ is very rarely offered to treat mania?

A

Lamotrigine, as it’s good for treating the depressive symptoms but has significant side effects

Can lead to stevens-johnsons syndrome (associated with rapid increase in dose)

21
Q

When should the treatment for mania be reviewed?

A

Within 4 weeks

22
Q

What are the guidelines for reviewing a patient on continued lithium treatment for BPAD?

A
  • Weekly monitoring of serum lithium levels when first prescribed
  • Once stable, 3 monthly monitoring of Us&Es, eGFR, 12 hr-serum lithium level, TFTs
  • If patients are lower risk, this is reduced to every 6 moths
23
Q

What is the first line pharmacological management if a patient presents with a severe depressive episode that’s not controlled with mood stabilisers?

A
  • Olanzapine with fluoxetine
  • Lamotrigine can be used instead of fluoxetine, but isn’t as good

Don’t use SSRIs alone

24
Q

What should be offered if there is no response to fluoxetine combined with olanzapine (or quetiapine on its own)?

A

Lamotrigine on its own

Same guidance applies if the patient is taking lithium or valproate

25
Q

When is a routine referral to CMHT recommended?

A

If there are features of hypomania

26
Q

What is the therapeutic range of lithium?

A

0.4-1.0mmol/L

27
Q

What is the toxic level for lithium?

A

1.2mmol/L

28
Q

How soon after starting lithium should plasma levels be checked?

A

1 week after starting or changing dose and monitored weekly until a steady therapeutic level is achieved (0.6-0.8mmol/L)

29
Q

What is the presentation of lithium toxicity?

A
  • GI disturbance
  • Polyuria/polydipsia
  • Sluggishness
  • Giddiness
  • Ataxia
  • Gross tremor
  • Fits
  • Renal failure
30
Q

What are the triggers for lithium toxicity?

A
  • Salt balance changes (eg. dehydration, D&V)
  • Drugs interfering with lithium excretion/ blood volume (eg. diauretics)
  • Accidental or deliberate overdose
  • Febrile illness/ travelling to a hot climate (excessive sweating)
31
Q

What is the management of lithium toxicity?

A
  • Check lithium level
  • Stop lithium dose (could precipitate symptoms of mania/ depression)
  • Transfer for medical care (rehydration, osmotic diuresis)
  • If overdose is severe, patient may need gastric lavage or dialysis
32
Q

Why is valproate given as sodium valproate?

A

Because this reduces the side effects

33
Q

What foetal abnormalities can lithium cause?

A

Ebstein’s anomaly

34
Q

What foetal abnormalities can valproate and carbamazepine cause?

A
  • Neural tube defects like spina bifida
  • Developmental disorders
  • PCOS (in the mother)
35
Q

What can be used in acute mania/ mania or hypomania if patients aren’t responsive to pharmacological interventions?

A

ECT

36
Q

What are the features of a manic episode?

A
  • Increased talkativeness/ pressured speech
  • Flight of ideas
  • Increased self esteem & grandiosity
  • Decreased need for sleep
  • Distractibility
  • Impulsive, reckless behaviour
  • Increased sexual drive, sociability or goal directed activity
37
Q

What are the causes of secondary mania?

A
  • Steroids
  • Hyperthyroidism
  • High cortisol
  • Drugs, medication
  • Frontal lobe disease
  • Infection
  • Caffiene
  • Myxoedema madness
  • Puerperal disorders
38
Q

What’s the gold standard long-term pharmacological treatment for BPAD?

A
  • Lithium
  • Or/ in addition to valproate/ olanzapine/ quetiapine

Very narrow therapeutic range: 0.4-1mmol/L

39
Q

What are the common side effects of lithium?

A
  • Fine tremor
  • Mild GI upset
  • Metallic taste in mouth
  • Sedation
40
Q

What are the side effects of persistent lithium use?

A
  • Renal disease/ CKD
  • Hypothyroidism
  • Lethargy
  • Weight gain
  • Persistent tremor
  • T wave flattening on ECG
  • Mild cognitive impairment
  • Change in hair texture
  • Mild leucocytosis
41
Q

Which drugs should be avoided if the patient is taking lithium?

A
  • NSAIDs
  • Diuretics like ACE inhibitors

Psych (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions