Bipolar Disorder Flashcards
Definition
chronic episodic mood disorder characterised by at least one episode of mania and a further episode of mania or depression.
Who else can be diagnosed with bipolar?
Either one can occur first but bipolar also includes those who at time of diagnosis only suffer with manic episodes as inevitably these will lead to development of depression.
Epidemiology
Bipolar
- Lifetime risk is 1-3%
- Mean age of onset is 19
- Higher in black and other minority ethnic groups
- Male : Female = 1:1
Pathophysiology
- Monoamine hypothesis - as well as low mood it also includes elevated mood due to increase of central monoamines
- Dysfunction of HPA axis - abnormal secretion of cortisol.
- Strong heritability - 40-70% MZT and 5-10% in first degree relative
- Stressful or significant life events - trigger first manic episode.
Neurochemical elements of bipolar
inc dopamine and serotonin
Endocrine element of bipolar
Inc cortisol, aldosterone, and thyroid
Causes and RF
4A3S
Aggressive Spenders
Age in early 20s
Anxiety disorders
After depression
Strong Fhx
Substance misuse
Stressful life events
Symptoms
I DIG FASTER
Irritability
Distractibility and Disinhibited
Insight impaired / Increased libido
Grandiose delusions
Flight of ideas
Activity / Appetite increased
Sleep decreased
Talkative
Elevated mood / energy increased
Reduced concentration / reckless behaviour and spending.
ICD 10 classification mania
Mania requires 3/9 symptoms :
- Grandiosity / inflated self esteem
- Decreased sleep
- Pressure of speech
- Flight of ideas
- Distractibility
- Psychomotor agitations
- Reckless behaviour
- Loss of social inhibitions
- Marked sexual energy
ICD 10 requirement of bipolar
Bipolar requires at least two episodes in which a persons mood and activity levels are significantly disturbed - one of which must be main or hypomania
5 states of bipolar
- Currently hypomanic
- Currently manic
- Currently depressed
- Mixed disorder
- In remission
MSE findings of bipolar
- Appearance - Flamboyant and unusual combination of clothing or personal neglect.
- Behaviour - Overfamiliar, disinhibited, increased psychomotor activity and distractible and restless.
- Speech - Loud, inc rate and quantity. Pressure of speech, uninterruptible, puns and rhymes, neologisms
- Mood - Elated, euphoric and or irritable
- Thought - Optimistic, pressured thought, flight of ideas, loosening of association, delusions
- Perception - No hallucinations. Mood-congruent auditory hallucinations rarely occur
- Cognition - Attention and concentration often impaired. Fully oriented
- Insight - Very poor
What is hypomania state
Mildly elevated or irritable mood ≥ 4 days. Partial insight reserved
Mania without psychosis
Hypomania but treated extent present for >1 week and complete disruption of work and social activities. May have grandiose ideas and excessive spending leading to debts. Sexual disinhibition and reduced sleep - exhaustion
Mania with psychosis
Severely elevated or suspicious mood with the addition of psychotic features - grandiose or persecutory delusions and auditory hallucinations. Aggression.
