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Psychiatry SOH > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

1
Q

Bipolar disorder can present similarly to depressive disorder. True or false?

A

True

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2
Q

Definition

A

2 or more episodes in which the patient’s mood and activity levels are significantly disturbed.
This disturbance consisting on some occasions of hypomania/mania, and on others, depression

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3
Q

What is the difference between bipolar I and bipolar II ?

A

Bipolar I is more severe
- current/past full blown mania + current/past depression

Bipolar II - current/past hypomania + current/past depression

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4
Q

Bipolar I is more common than bipolar II. True or false?

A

False

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5
Q

Patient has NEVER met criteria for manic episode in bipolar II. True or false?

A

True

- only met criteria for hypomanic episode

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6
Q

A single episode of hypomania or mania is enough to diagnose bipolar disorder (even if the patient hasn’t been depressed yet). True or false?

A

True

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7
Q

The first episode of (hypo)mania on a background of depression has what significance?

A

The patient should be re-diagnosed with BIPOLAR DISORDER and not depression anymore

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8
Q

Classification of hypomanic episodes

A

Elevated/irritable mood to a degree that is definitely abnormal for the individual and this is sustained for at least 4 consecutive days.

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9
Q

A patient who is hypomanic will have psychotic symptoms. True or false?

A

False

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10
Q

Classification of hypomanic episodes - signs

A

At least 3 of the following should be present:

  • increased activity or physical restlessness
  • increased talkativeness
  • difficulty in concentration or distractibility
  • decreased need for sleep
  • increased sexual energy
  • mild spending sprees, or other types of reckless or irresponsible behaviour
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11
Q

Classification of manic episodes

A

Mood must be predominantly elevated, expansive or irritable, and definitely abnormal for the individual. The mood change must be prominent and sustained for at least 1 week.
Presence of psychotic symptoms

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12
Q

Classification of manic episodes - signs

A

At least 3 of the following signs:

  • increased activity or physical restlessness
  • V increased talkativeness (pressure of speech)
  • Flight of ideas (racing thoughts)
  • Loss of normal social inhibitions resulting in inappropriate behaviour
  • decreased need for sleep
  • inflated self esteem or grandiosity
  • distractibility or constant changes in activity or plans
  • reckless behaviour where the subject doesn’t recognise the risks
  • marked sexual energy
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13
Q

Hypomania vs mania

A

Hypomania is clinically similar but not as severe as mania.
Manic episodes cause more impairment in function.
Manic episodes have psychotic symptoms.
Behaviour is more reckless in manic episodes.

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14
Q

Onset

A

Usually late teens - early 20s

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15
Q

Family history of bipolar disorder often results in earlier onset. true or false?

A

True

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16
Q

The amount of time people spend in euthymia (normal mood) is HIGH/LOW?

17
Q

MSE - appearance

A

Wears bright clothes

Bright makeup

18
Q

MSE - behaviour

A

Distractibility

Loss of normal social inhibitions / over-familiarity
eg swearing at drs appt

19
Q

MSE - speech

A

Increased talkativeness
Pressured speech
Puns

20
Q

MSE - thoughts

A 
Increased flow - unable to keep track of what pt is talking about 
leaping between different convo topics 
Flight of ideas 
Grandiosity - pt thinks they are great 
Delusions
21
Q

MSE - perception

A

Normal
or
Hallucinations
- only with MANIC episodes (not hypomanic episodes)

22
Q

If the patient has hallucinations then what do they have?

A

Mania + psychotic symptoms

23
Q

MSE - cognition

A

Loss of concentration

Mainly orientated

24
Q

MSE - insight

A

Often no insight

25
Q

Prognosis

A

Predictors of poor outcome in adolescents

Suicide risk

26
Q

Acute treatment (manic episode)

A

Want to reduce mood in episodes of mania

  • Anti-psychotics (oral)
  • Benzodiazepines can be used for symptom control
27
Q

Acute treatment (depressive episode)

A

Want to raise mood in episodes of depression
- Anti-depressants
ADs SHOULD NOT BE PRESCRIBED UNLESS THERE IS A MOOD STABILISER ALSO PRESCRIBED

28
Q

Long term management

A

Mood stabilisers

29
Q

What is the function of mood stabilisers?

A

To stabilise mood and prevent recurrence of both mania and depression

30
Q

List 4 types of mood stabilisers

A

Lithium - gold standard
Anti-psychotics
Lamotrigine (if primarily depression)
Sodium valproate (if primarily manic/hypomanic)

31
Q

It is not possible to give anti-depressants alone in bipolar disorder. What must they be combined with?

A

Mood stabiliser

32
Q

Is psychological therapy useful in bipolar disorder?

A

Yes

  • CBT
  • Behavioural activation

Psychiatry SOH (19 decks)

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