Bipolar disorder Flashcards
What would be a characteristic presentation of mania?
DIG FAST:
- Distractibility
- Irresponsibility
- Grandiose delusions
- Flight of ideas
- Activity increase
- Sleep deficit
- Talkativeness
How do you differentiate between hypomania and mania?
DSM-4:
Hypomania:
- At least 4 days
- Clearly different from usual non-depressed mood
- Change in functioning, uncharacteristic of patient when asymptomatic
- Not severe enough to cause marked impairment in social/occupational functioning or hospitalistion
- No psychotic features
Mania:
- Lasts at least a week
- Clearly different from usual non-depressed mood
- Change in functioning, uncharacteristic of patient when asymptomatic
- May be severe enough to warrant hospitalisation
- May have psychotic features
How should an assessment be done on an intoxicated patient?
- On-call psychiatry should assess the patient
- Request MHA assessment once patient is sober
What are the symptoms of delirium tremens?
- Autonomic hyperactivity
- Tachycardia
- Fever
- Insonmia
- Anxiety
- Hypertension
- Perceptual distortions
- Visual/tactile hallucinations (formication - insects crawling)
- Fluctuating motor activity
- Delirium
How is delirium tremens managed?
- Benzodiazepine
(Usually Chlorodiazepoxide) - Rehydrate with IV fluids and Pabrinex
(Prevents Wernicke’s encephalopathy)
Once stable:
- Gain history of alcohol use
What is Wernicke’s encephalopathy?
Wernicke’s:
- Acute neurological condition
- Life threatening
- Caused by thiamine deficiency
- Can result in Korsakoff syndrome
Triad:
- Opthalmoparesis with nystagmus
- Ataxia
- Confusion
What is Korsakoff syndrome?
Korsakoff:
- Consequence of at least one episode of Wernicke’s
- Preventable
- Neuropsychiatric disorder
- Memory disturbances
- Deficits in anterograde and retrograde memory
- Immediate memory is maintained
- Patient’s can fabricate stories
What is the DSM-5 criteria for bipolar disorder?
Lows same as major depressive disorder
- Hopeless and discouraged
- Lack energy and focus
- Eating changes
- Sleeping changes
Also have manic episodes
- Distinct period of elevated/irritable mood
- Increased activity/energy
- At least 1 week
Symptoms:
- Inflated self-esteem and grandiosity
- Decreased need for sleep
- More talkative, pressured speech
- Flight of ideas
- Distractibility
- Increase in goal-directed activity
- High-risk behaviour
How does bipolar I present?
- Strong lows lasting 2 weeks or more
- Major highs lasting at least 1 week
How does bipolar II present?
- Strong lows lasting 2 weeks or more
- Smaller highs that are more hypomanic, lasting at least 4 days
How does cyclothymia present?
- Milder lows AND highs
- Cycle between the two for at least 2 years
What is rapid cycling?
4 or more episodes of depression or mania within a year
What are mixed episodes?
Episodes that have both depressive and manic symptoms
What does lithium do?
- Much better for manic episodes
- Mood stabilisation
- Smooths out highs and lows
What is the ICD-10 criteria for dependence syndrome?
3 of the following, present together within the previous year or constantly over 1 month:
- A strong desire/sense of compulsion to take the substance
- Difficulties in controlling substance-taking behaviour in terms of onset, termination, or levels of use
- Evidence of tolerance
- A physiological withdrawal state
- Progressive neglect of alternative pleasures or interests due to substance use
- Increased amount of time necessary to obtain/take the substance or to recover from its effects
- Persisting with substance use despite clear evidence of overtly harmful consequences
The patient must feel a desire to take the drug.
