Bipolar Disorder (2) Flashcards
What is this?
What is a Depressive episode defined as?
What is a Hypomanic episode defined as?
What is a Manic episode defined as?
➊ Recurrent episodes of depression and mania/hypomania
➋ Period lasting >2 weeks of either low mood or anhedonia (or irritability in children and adolescents), accompanied by at 4+ additional depressive symptoms
➌ Similar to a manic episode but symptoms last for 3+ days, and is not severe enough to cause marked impairment in social or occupational functioning or necessitate admission, and there are no psychotic features
➍ Period of persistently elevated, expansive, or irritable mood lasting > 1 week, accompanied by 3+ additional symptoms, and is severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalisation, or which includes psychotic features
N.B. The main difference between mania and hypomania is the presence of psychotic symptoms.
What are the clinical features expected in a MSE?
• A - Dressed inappropriately, privately, or outlandishly
• B – Irritability, Restlessness, Distractable, Flirtatious, Increased psychomotor activity, Increased libido, Disinhibition, Extreme spending
• S – Loud, Fast rate, Uninterruptible, Flight of ideas, Pressure of speech
• MA – Euphoric (Elevated mood), which can quickly turn to irritability and anger
• T
‣ Form – Pressured, Tangentiality, Circumstantiality
‣ Content – Grandiose delusions
• P - Auditory hallucinations, which is often mood congruent
• C - Attention and concentration often impaired
• I - Poor
What are the differentials?
How is it investigated?
➊ ● Unipolar depression – more likely with onset after 25 yrs, and w/o family hx of bipolar
● Cyclothymia – Chronic mood disturbance between mild depression and hypomania, where depressive symptoms don’t meet the criteria for a depressive episode
● Schizophrenia – more likely in absence of prominent mood symptoms
● Substance misuse, Iatrogenic, Metabolic disorders
➋ Exclude other causes, like substance misuse
How is it managed acutely?
How is it managed prophylactically?
➊ ● Antipsychotics – Olanzapine, Risperidone, Haloperidol, Quetiapine
‣ If 2 antipsychotics don’t work, Lithium or Sodium Valproate may be added (avoid in pre-menopausal women)
● Stop any antidepressants as it can exacerbate manic episode
➋ Mood stabilisers, like Lithium or Sodium Valproate – Help prevent both mania and depression, and are quite effective
● Lithium has a narrow therapeutic range, therefore its levels have to be carefully monitored to avoid toxicity - Before starting, check renal and thyroid function, and advise contraception in women
N.B. Lithium therapeutic dose → fine tremor. Toxic dose → coarse tremor.
