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Mental health > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

1
Q

What is bipolar disorder?

A

A mental illness characterised by depressive episodes and (hypo)manic episodes

Patients may be euthymic between these episodes.

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2
Q

What are the different types of bipolar disorder

A
  • Bipolar I: ≥1 manic episode ± history of major depression
  • Bipolar II: ≥1 hypomania (no mania) ± ≥1 major depression
    • Typically less severe; does not inhibit function
  • Cyclothymic: cyclic brief hypomania + depression
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3
Q

Outline the DSM-5 diagnostic criteria for bipolar disorder

A
  • At least two episodes
  • One of which must be either:
    • Mania
    • Hypomania
    • Mixed affective.
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4
Q

What is a manic episode?

A
  • Abnormal persistently elevated, expansive, or irritable mood
  • ≥7d (unless hospitalised)
  • Additional 3+ symptoms:
    • Increased energy/activity; restlessness
    • Pressure of speech; incomprehensible speech
    • Flight of ideas; racing thoughts
    • Distractibility; poor concentration
    • Increased libido; disinhibition; sexual indiscretions
    • Extravagant/impractical plans
    • Psychosis
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5
Q

What is a hypomanic episode?

A
  • 3+ symptoms of mania: less severe
    • No marked social/functional impairment
    • No psychosis
  • ≥4 days
  • May present with
    • Mild elevation of mood; irritability
    • Increased energy/activity; improved performance
    • Feelings of well-being; physical and mental efficiency
    • Increased sociability; talkativeness; over-familiarity
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6
Q

Outline the DSM-5 criteria for depression

A
  • 5+ symptoms (must have one of bold), for ≥2/52
    • Depressed mood
    • Anhedonia
    • Significant weight change or appetite disturbance
    • Sleep disturbance
    • Psychomotor agitation/retardation
    • Fatigue; lethargy
    • Feelings of worthlessness
    • Diminished ability to think/concentrate; indecisiveness
    • Recurrent thoughts of death; suicidal ideation/attempt
  • Causing significant distress/impairment
  • Not attributable to substance use; another medical condition
  • Not better explained by psychotic disorders
  • No PMH of (hypo)mania
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7
Q

Outline the severity of depression

A
  • Subthreshold: Persistent if >2yrs
    • <5 symptoms of depression
  • Mild:
    • Few, if any, symptoms in excess of 5 required
    • Minor functional impairment
  • Moderate:
    • Symptoms or impairment between mild/severe
  • Severe:
    • Most symptoms
    • Marked functional impairment ± psychosis
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8
Q

What is a mixed episode?

A
  • Either
    • (Hypo)mania and depression in a single episode
    • Rapid alteration between (hypo)mania and depression
  • Every day for 2/52
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9
Q

What is rapid-cycling bipolar disorder?

A

≥4 episodes within 12-months

Episodes can be depressive; (hypo)manic; or mixed

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10
Q

What is the difference between bipolar disorder with psychotic symptoms, and schizoaffective disorder?

A
  • Bipolar with psychotic symptoms: mood congruent delusions
  • Schizoaffective: no mood congruent delusions
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11
Q

State three distinguishing features between bipolar disorder and unipolar depression

A

Favouring bipolar disorder over unipolar depression:

  • Hypersomnia; lability; weight instability
    • 90% of bipolar disorder; 50% of unipolar depression
  • Earlier age of onset; abrupt onset
  • More frequent brief episodes
  • Comorbid substance misuse
  • Psychosis; psychomotor retardation; catatonia
  • Lower likelihood of somatic symptoms
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12
Q

How can bipolar disorder episodes be described?

A
  • Current
    • Hypomanic
    • Manic ± psychosis
    • Mild or moderate depression
    • Severe depression ± psychosis
    • Mixed
  • In remission
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13
Q

What is the median age of onset for bipolar disorder?

A

25 years

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14
Q

How does bipolar disorder vary between sexes?

A
  • Equal incidence between sexes
  • Bipolar II and rapid cycling is commoner in females
  • Males tend to first experience manic episodes
  • Females first experience depressive episodes
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15
Q

How does bipolar disorder impact suicide risk?

A

Bipolar disorder has 20x rate of attempted suicide

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16
Q

Name two significant co-morbidities seen with bipolar disorder

A
  • Drug/alcohol misuse
  • Anxiety disorders

Both increase risk of suicide

17
Q

State three predisposing factors for bipolar disorder

A
  • Bio: Genetic factors
  • Psycho: Childhood experiences
  • Social:
18
Q

State two precipitating factors of bipolar disorder

A
  • Bio: Substance misuse, iatrogenic eg. steroids
  • Psycho: Self role
  • Social: Life events, change in routine
19
Q

Outline the perpetuating factors of bipolar disorder

A
  • Bio: Substance misuse, physical illness
  • Psycho: Personality traits
  • Social: Work, relationships, support
20
Q

List five complications of bipolar disorder

A
  • Suicide; deliberate self harm
  • Disinhibition and impaired social functioning
    • Alcohol and substance misuse
    • Financial difficulties due to overspending
    • Traumatic accidents
    • STIs; unplanned pregnancy
    • Self-neglect
    • Exploitation
  • Anxiety disorders; personality disorders; ADHD
  • HTN; cardiovascular disease
  • T2DM; metabolic syndrome; CKD
21
Q

What is the likelihood of relapse in bipolar disorder?

A

80% relapse after 1st episode within 5-7 years

22
Q

Outline the management of bipolar disorder

A
  • Risk management plan: developed with service user
  • Psychotherapy
    • Evidence-base manual specific for bipolar disorder
    • High-intensity CBT; IPT; behavioural couples therapy
  • Treatment of (hypo)manic episodes
  • Treatment of depressive episodes
  • Relapse prevention:
    • Family intervention; psychotherapy
    • Lithium
      • Consider valproate; olanzapine; quetiapine
  • Social: Targeted interventions towards family, housing, finance, employment
23
Q

Which subtypes of bipolar disorder respond less well to lithium?

A
  • Mixed bipolar disorder
  • Rapid cycling mania
24
Q

What medication should be avoided in bipolar?

Why?

A

Antidepressants

Poor evidence of efficacy, and risk of switching to mania

25
Q

Which bipolar medications should be avoid in woman of child bearing age?

A
  • Lithium: Epstein’s anomaly
  • Sodium valproate: neural tube defects
  • Carbamazepine: neural tube defects
26
Q

Outline the pharmalogical management of a (hypo)manic episode of bipolar disorder

A

Consider stopping antidepressants

  1. Haloperidol; olanzapine; quetiapine; or risperidone
  2. Switch to an alternative SGA listed above
  3. Add lithium if uncontrolled after trying two SGAs
    1. Sodium valproate if ineffective/not suitable
  4. ECT in severe refractory mania
27
Q

Outline the management of a depressive episode of bipolar disorder

A
  1. Fluoxetine + olanzapine; or quetiapine monotherapy
  2. Lamotrigine monotherapy
28
Q

How do psychotic symptoms tend to present in a manic episode of bipolar?

A
  • Mood congruent delusions: grandiose or persecutory
  • Hallucinations
29
Q

What are the indications for ECT?

A
  • Severe depressive illness that is resistant to other treatment
  • Life threatening mental illness
  • Prolonged and severe mania
  • Catatonia
  • High suicide risk
  • Stupor
  • Severe psychomotor retardation

Mental health (27 decks)

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