Bipolar disorder

Question 1

bipolar disorder definition

Answer 1

disorder characterized by dramatic shifts in emotions, moods and energy levels from extreme highs to extreme lows

Question 2

depressive episode + symptoms ( 6 )

Answer 2

1. shows symptoms and presents the same as unipolar depression
2. diagnosed when it lasts > 2 weeks minimum
3. Features include
4. persistent low mood + suicidal thoughts
5. low energy and focus
6. loss of pleasure and interest (anhedonia )
7. lack of appetite

Question 3

manic episodes

Answer 3

1. a distinct period of abnormally elevated and persistently heightened emotions
   Episode is only diagnosed when;
2. lasts >7 days or more
3. minimum of 3 symptoms
4. severe enough to cause severe social/occupational functioning

Question 4

manic episode symptoms ( 6 )

Answer 4

1. increased energy + restlessness
2. decreased need for sleep + insomnia
3. racing thoughts + poor conc
4. increased libido + sexual inhibitions + STI
5. Extravagant spending ( shopping sprees + gambling)
6. incomprehensible + pressured speech
7. psychotic symptoms of delusions + hallucinations

Question 5

hypomania

Answer 5

1. symptoms of mania are not severe enough to cause marked impairment in social or occupational functioning
2. no psychotic features
3. epsiodes of less severe high

Question 6

diagnosing hypomania

Answer 6

1. symptoms last for only 4 days
2. not severe enough for impairment socially or otherwise
3. no psychosis

Question 7

cyclothymia

Answer 7

1. milder lows and milder highs

2. patients cycle between hypomania and milder lows for atleast 2 years or more

Question 8

bipolar 1

Answer 8

1. major lows (depressive episodes) lasting a minimum of two weeks
2. major highs (manic episodes) lasting more than 1 weeks thus requiring hospitalisation during this time

Question 9

bipolar 2

Answer 9

1. Major lows (depressive episodes) lasting minimum of 2 weeks
2. less extreme high episodes (hypomanic episodes) lasting for 4 days minimum

Question 10

mixed episodes

Answer 10

1. experience symptoms of depression and mania at the same time
2. rapidly alternate from mania to depression in the matter of a few hours

Question 11

rapid cycling

Answer 11

1. 4 or more episodes of depression or mania in a given year

2. minimum of 4 depressive, manic, hypomanic or mixed episodes within a 12 month period

Question 12

etiology of bipolar disorder (4)

Answer 12

exact underlying cause of bipolar disorder is unknown

1. patients with family members with bipolar disorder are 10 x more likely to have it
2. drugs + medication can trigger manic episodes e.g. SSRI used in depression can induce manic episodes in suscep patients
3. dysfunction of hypothalamic-pituitary-adrenal axis - abnormal secretions of cortisol found in unipolar depression
4. psychosocial - traumatic experiences/in childhood can predispose patients

Question 13

what kind of questions to ask?

Answer 13

1. do you experience moods that are higher than normal?
2. do you feel more irritable than usual?
3. do you ever have increased energy than usual?
4. how much do you sleep?
   PATIENTS TEND TO PRESENT TO THE DOCTOR MORE WITH DEPRESSIVE EPISODES

Question 14

management of bipolar disorder?

Answer 14

1. refer all patients to specialist mental health assesment unit where diagnosis can be made (<14 = CAMHS)
2. Evaluate risk of harm to self and to others
   - suicidal idealation -> suicidal intent ->
   - alcohol + drug misuse
   - financial ruin/sti/pregnancy
   - adult safeguarding -> risk of exploitation
   - risk to others -> dependants?

Question 15

treatment of bipolar disorder

Answer 15

1. Lithium salts - lithium acts as a mood stabiliser. More effective at treating mania than depressive symptoms
2. Antidepressants - SSRI are contraindicated as they can trigger mania
3. CBT - not very effective but can help handle stressful situations
4. Antipsychotics/Benzodiazapine/ Anticonvulsant

Question 16

incidence + prevalence

Answer 16

1. Bipolar I disorder - 1% and Bipolar II disorder - 0.4%
2. First episode diagnosed < 30 years
3. Equally distributed between men + women
   4, incidence rates are higher in black + ethnic minorities

Question 17

differential diagnosis of bipolar disorder

Answer 17

1. unipolar depression - chronic disturbance of mood
2. cyclothymia
3. schizophrenia - in mania, delusions and hallucinations are mood congruent
4. substance abuse + stimulant drugs ( cocaine / ecstasy)
5. personality disorders
6. ADHD
7. iatrogenic causes - antidepressants such as SSRI