Bipolar Affective Disorder Flashcards

1
Q

What is bipolar affective disorder?

A

Characterised by recurrent episodes of depression and mania or hypomania

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2
Q

What age do symptoms typically start in bipolar disorder?

A

Under 25

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3
Q

What is bipolar disorder associated with?

A

Suicide

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4
Q

What are depressive episodes?

A

Episodes which feature :
- Low mood
- Anhedonia
- Low energy

Can be severe

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5
Q

What are manic episodes?

A

Episodes involving excessively elevated mood and energy

Significantly impacts their normal functions
Very disinhibited
Unable to function
More than 7 days

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6
Q

What are hypomanic episodes?

A

Milder symptoms of mania without significant impact on their function
Only lasts a few days
Able to continue functioning
No feelings of grandiosity
Less than 7 days

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7
Q

What are mixed episodes?

A

Mix of symptoms or rapid cycling between mania and depression

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8
Q

What are features of mania?

A
  • Elevated mood
  • Irritability
  • Energetic
  • Insomnia
  • Grandiosity, ambitious plans, excessive spending, risk taking
  • Disinhibition
  • Flight of ideas
  • Pressured speech
  • Psychosis
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9
Q

How is bipolar disorder diagnosed?

A

Diagnosis made by specialist

Based on

ICD-11

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10
Q

What is Bipolar affective disorder I?

A

Two distinct mood episodes

Involves at least one episode of mania

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11
Q

What is Bipolar affective disorder II?

A

One episode of major depression

One episode of hypomania

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12
Q

What is cyclothymia?

A

Milder symptoms of hypomania and low mood

Symptoms not severe enough to significantly impact their function

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13
Q

What is unipolar depression?

A

Person only has episodes of depression without hypomania or mania

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14
Q

How is an acute episode of bipolar disorder managed?

A

Secondary care specialists should manage it

Requires referral for urgent mental health assessment or hospital admission

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15
Q

How is an acute manic episode treated?

A

Antipsychotics (olanzapine, quetiapine, risperidone or haloperidol) first line

Mood stabilisers

Lithium and sodium valproate
Existing antidepressants tapered and stopped

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16
Q

What treatment options are used for an acute depressive episode?

A

Olanzapine + fluoxetine
Antipsychotics (olanzapine or quetiapine)
Lamotrigine

17
Q

What is the long-term management of bipolar disorder?

A

Lithium

18
Q

Why are serum lithium levels monitored so closely?

A

Lithium toxicity occurs if dose and levels too high

Target range is 0.6-0.8mmol/L

19
Q

When are serum lithium levels monitored?

A

12 hours after most recent dose

20
Q

After changing dosage in lithium use when should serum lithium levels be checked?

A

Checked after 1 week and weekly until the levels are stable

21
Q

What are the adverse effects of lithium?

A

Fine tremor
Weight gain
CKD
Hypothyroidism and goitre
Hyperparathyroidism and hypercalcaemia
Nephrogenic diabetes insipidus

22
Q

What are some signs of lithium toxicity?

A

Coarse tremor
Nausea
Vomiting
Confusion
Ataxia
Muscle weakness
Seizures

23
Q

Why can you get hypothyroidism and goitre in lithium use?

A

Inhibits production of thyroid hormones

24
Q

What are some alternatives to lithium for long-term management of bipolar disorder?

A

Sodium valproate
Olanzapine

25
Q

What are the strict rules in place for sodium valproate and why?

A

Teratogenic

Causes neural tube defects and developmental delay if used in pregnancy

Strictly avoided in childbearing women unless no suitable alternatives

26
Q

What are the main side effects of sodium valproate?

A

VALPROATE

Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Really big (weight gain)
Oedema
Anorexia
Tremor
Enzyme inhibiton

27
Q

How does sodium valproate work?

A

Blocks voltage-dependent sodium channels to suppress high frequency neuronal firing

Inhibitior of CYP hepatic enzmyes

28
Q

What must a female patient of childbearing age do when taking sodium valproate?

A
  • Patient must use effective contraception
  • Sign an annual risk acknowledgement form
29
Q

What does duration of untreated psychosis lead to?

A

Leads to poorer prognosis

30
Q

Why does bipolar have a high rate of suicide?

A

After recovering from mania, patients often highly embarrassed from their symptoms during mania

Or if they bought expensive items e.g. a car and are financially struggling

31
Q

What is a grandiose delusion?

A

Hightened sense of self-worth/power/knowledge or believes they have powers no one else does

32
Q

What is a Biazarre delusion?

A

Perosn adamant about a belief that is not possible, understable or related to normal life

33
Q

What is circumstantiality?

A

Inability to answer a question without giving excessive, unnecessary detail

34
Q

How does carbamazepine work?

A

Bind to voltage-dependent sodium channels to inhibit high frequency neuronal firing

Induces liver enzymes

35
Q

What serious condition can carbamazepine cause?

A

Steven-Johnson Syndrome

Avoid in South asians / HLAB1502 enzyme

36
Q

What are the side effects of carbamazepine?

A

Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Bone marrow suppression
ADH release
Eosinophilia