bipolar disorder Flashcards
what is bipolar affective disorder?
characterised by alternating periods of depressive and elevated mood (mania or hypomania)
what are the types go BPAD?
BPAD Type 1: One or more manic episodes and one or more depressive episodes.
BPAD Type 2: Recurrent major depressive episodes and hypomanic episodes.
how do you diagnose BPAD via ICD11?
what is mania?
Severe functional impairment or psychotic symptoms persisting for at least seven days.
what is hypomania?
Increased or decreased function for at least four days without psychotic symptoms.
triggers for BPAD?
Stressful life events, physical illness, or illicit substance misuse can trigger manic episodes.
medication induced causes of BPAD?
A ‘manic switch’ can be induced by antidepressants (e.g. SSRIs) when treating a depressive episode.
what are the clinical features of BPAD?
depressive phase, manic phase
Psychotic symptoms (delusions, hallucinations) and risk-taking behaviors (sexual disinhibition, spending/gambling, violence).
what is seen in the depressive phase?
Low mood, feelings of worthlessness, decreased energy, and suicidal ideation.
what is seen in the manic phase?
Elevated or irritable mood, inflated self-esteem, decreased need for sleep/sleep disturbance (is both a feature of, and can precipitate manic episodes), impulsivity, pressured speech, and potential psychotic symptoms.
how do you investigate BPAD?
when does BPAD usually develop?
late teens
who can manage what in BPAD?
what is the management of acute mania/new BPAD diagnosis?
STOP SSRI
mania with agitation = Intramuscular neuroleptic or benzodiazepine, potential psychiatric admission.
mania w/o agitation = Oral antipsychotic monotherapy (haloperidol, olanzapine, quetiapine, or risperidone). Potential addition of sedatives or mood stabilizers, such as lithium if antipsychotics are unsuccessful. Electroconvulsive therapy (ECT) is a last resort.
what is the management of acute depression/new BPAD diagnosis?
Mood stabilizer dose increase if alread taking. If not on established mood stabilizer, consider SSRI and atypical antipsychotic cover.
what is chronic BPAD management?
4 wks post acute ep
mood stabilisers eg lithium or valproate
High-intensity Psychological Therapies: Cognitive-Behavioral Therapy (CBT), Interpersonal Therapy.
complications of BPAD?
suicide risk
recurrence of manic eps
what are the risks of BPAd with co-morbidities?
there is a 2-3 times increased risk of diabetes, cardiovascular disease and COPD
what is the adntidepressant of choice in managing depressive eps?
fluoxetine
what improves outcomes of BPAD?
Early and consistent management improves outcomes.