Bipolar disorder Flashcards
Which gender is bipolar more common in, and which ages for each?
Equal male: female. 15-19 for women and 20-24 for men
Give 3 mood, 5 cognitive, 5 behavioural and 2 psychotic clinical features suggestive of mania.
Mood: Irritability, euphoria, labile mood.
Cognition: Grandiosity, distractibility, flight of ideas, confusion, lack of insight, impaired judgement, extreme risk taking.
Behavioural: Pressure, hyperactivity, decreased need for sleep, hypersexuality, extravagance, social disinhibition.
Psychosis: Delusions, hallucinations.
What is needed with the symptoms to diagnose mania?
Symptoms lasting over a week (or shorter, but severe enough to warrant hospital admission) and a loss of function.
What is bipolar? What is it characterised by?
Depression alternating with mania. Characterised by repeated (i.e. >2) mood disturbances.
How quick do manic episodes normally onset and how long do they normally last?
Usually begin suddenly, lasting anywhere from 2 weeks to 4-5 months.
What are types 1 and 2 bipolar affective disorder?
Type I: mania + depression. Type II: repeated depression with hypomanic episodes.
What is hypomania and how does it differ from mania?
It is a less severe state of mania. There are no psychotic symptoms, decrease in functioning, or need for hospital admission. It has to last >4 days.
What is cyclothymia?
Cyclical mood swings with subclinical features (‘bipolar lite’)
Give 2 drug causes of mania, and 6 physical.
Drug: STEROIDS, amphetamines/cocaine.
Physical: Hyperthyroid, infection, stroke, tumour, epilepsy, multiple sclerosis. Also STRESS/GRIEF.
Give 2 investigations you could do in a manic patient.
CT head, TFTs, etc etc depending on suspected cause
How is acute mania treated?
Any SGA. Lithium can also be started in a manic episode. Remember that people like being manic so can be difficult to treat
When should prophylaxis be considered for bipolar mania?
If, after treatment of an acute episode of mania, there is a relapse.
What is first line medical treatment, and what evidence is there for it?
Lithium. Only drug in bipolar that has evidence for decreasing suicide.
How often should dose be checked and what levels are optimum?
Check it weekly until consistent, then check monthly for 6 months, then 3 monthly.
0.4-1
If lithium levels gradually increase, what could be happening?
Nephrotoxicity
Lithium toxicity
What bloods need to be monitored and how often?
TFTs and U+Es 6 monthly
What is second line if lithium isn’t working?
Semisodium valproate or carbamazepine
Give 2 other mood stabilisers that can be used.
Lamotrigine (is as good as SSRIs for bipolar depression treatment), and olanzapine. Quetiapine can be used, good for mania and depression.
When would combination treatment be considered?
After persistent, long term mania. Can combine lithium with any of the above.
What can be used for depression in bipolar?
SSRIs, venlafaxine, ECT, and as mentioned above, lamotrigine
What is the mainstay of psychological treatment and what does this target?
CBT. Support groups and psychoeducation are also very important. CBT targets topics such as stigma, fear of relapse, acute illness, reckless habits and hypersexuality
