Bipolar Disorder

Question 1

What are the main features?

Answer 1

Normal mood is disturbed with depressive and manic episodes.
Sooner or later-> depression.

Question 2

What is BD synonimus with?

Answer 2

Manic depression

Manic depressive psychosis

Question 3

Whats unipolar manic disorder?

Answer 3

Not a category, as almost everyone with mania sooner or later become depressed.

Question 4

Whats cyclothemia?

Answer 4

Mild, chronic bipolar diorder.
Like dysthemia, thought as personality trait.

Mild mood evelavtion assc with productivity and creativity so no psychiatric help needed.

Question 5

What are the categories?

Answer 5

ICD-10 says:
1 manic episode

Or

2 manic episodes/+- depressive –> bipolar. Eg dx bipolar disorder current episode manic.

Question 6

Tx of mania??

Answer 6

Usually admit, often compulsory,and may need restriction.

Antipsychotic for psychotic sx, (antimanic)
Benzodiazepines for sedation.
Lithium, ECT, Na valproate 2nd line tx.

Lithium already? Check blood levels for adherence.

Untreated mania- can last for M!
DEATH FROM MANIC EXCHAUSTION- well recognised.

Question 7

How do u treat the depressive disorders in BD?

Answer 7

Depressive epidsodes in BD usually Severe .

In addition to use of antiD, there may be need for lithium or antipsychotics (partly cz antidepressants used alone can precipitate mania) . Admission and ECT may be necessary.

Question 8

What is ECT? When is it indicated?

Answer 8

Electroconvulsive therapy
Triggers an epileptic fit, to releve severe depression
Used to tx mania or catalonia.
Done under general anaesthisia and muscle relaxants so tha body only twitches slightly and does not covulse during fit.

Indicated in severe D, unresponsive to meds or talking tx,
Have found it helpful in the past, and asked to redo it.
Are catalonic: staying frozen in 1 position, or repeating movements, or being restless, unrelated to meds.

Severe postnatal depression- works very quickly, it can minimise the time ppl are unamble to bond with their baby.

Question 9

What is the prophylaxis of bipolar D?

Answer 9

Long term lithium reduces relapse risk.
Tx early may improve its outcome.
Lithium should be offered to all those who have had 2 manic episodes.
Or 1 manic and 1 depressive.

❌ do not prescribe if pt or dr will not contiune it for 2Y. Stopping it earlier carries a high risk of rebound mania.

Councelling and patient education needed b4 Li.
1/3 cant take it or doeant work.

Altrenatives: Carbamezapines and Sodium Valproate.
There are signs- eg deteriorating sleep.
Patients can learn to recognise warning signs.

Question 10

Prognosis

Answer 10

Remitting relapsing course

Worse in young-onset cases, .
Suicide risk similar to depression disorders.

Disruption caused by illness, esp manic phases, often leads to problems in apmanintaining relationships, accomodation, employemnt.

Question 11

Aetiology?

Answer 11

Strongly heritable

Monozygotic: dizygotic 75:25.
Relatives : ⬆️ risk of both bipolar and unipolar depressive disorder.

Loci on chromosome 18 and X.evidence for maternal inheritence.

No childhood risk factors are known.
Life events can precipitate the initial episodes, but once established, env fx wont be affecting it.

Neurobiologically, monomanine systems addected suspected.

❗️ always consider drug induced mania- eg organic mood disorder.
In young ppl with no fhx of BD.

Question 12

What should you exclude in someone coming in middle aged?

Answer 12

CVA disease
Tumours
Medication side effects

Question 13

Sx of mania?

Answer 13

Irritable or elevated mood
Flight of ideas
Xs energy
Insomnia
Wt loss
Delusions (grandiose- self confident, wealth!! Power, persecutory- religion influence- debts!!)
Increased libido and sexual activity
Disinhibition 

Impulsive behaviours- drinking, spending, speeding.

Hypomania- lacks a psychotic element. Just happy for no reason.

Question 14

Ddx?

Answer 14

Acute Intoxification of recrational drugs- like amphetamines, MDMA and cocaine can minic mania.

1/4 of Cushings, develop mania.

Corticosteroids (just like stress hosmone cortisol) , Dopamine agonsists like Bromocriptine- cal also cause mania.
Antidepressants can precipitate mania in bipolar disorder.

Question 15

Main tx?

Answer 15

Acute mania: Antimanic drug,
Lithium is the primary drug used or Na valproate.

Li- effective in reducing frequency and severity of episodes of mania
+++ Reduces risk of suicide ! ( so major depressive disorders)

Question 16

What do u need to do with lithium tx?

Answer 16

Narrow therapeutic window- plasma levels should be checked weekely

1. Avoid dehydration
2. Not to be co-prescribed with NSAIDs and Diuretics

Question 17

What are the SE of Li?

Answer 17

Nausea
Diarrhoea
Wt gain
Polyurea
Tremor