Bipolar Disorder Flashcards
According to ICD-10:
How many episodes of depression or mania/hypomania is needed?
How long should it last for?
How much time between episodes?
What is the commonest age of onset?
2 or more episodes
> 2 wks
Several months apart
Teens and 20’s
What does rapid cycling BD mean?
What is cyclothymia?
What is dysthymia?
4 affective episodes in one yr
A milder form of BD with persistent instability of mood, involving numerous periods of mild depression and elation.
Chronic depression basically
What is the difference between BD Type 1 and BD Type 2
The main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type.
A person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode (a period that’s less severe than a full manic episode).
Hypomania - ICD-10:
How long should symptoms last for?
How do you know it is hypomania?
What 2 things are definitely absent from hypomania?
4+ days
Behaviour is definitely abnormal for individual
Psychosis and little functional impairment
Remember, PSYCHOSIS can occur with mania
Hypomania - ICD-10:
List criteria where you’d pick 3 or more to diagnose?:
- Cognition - 1
- Behaviour - 7
Increased activity/physical restlessness
Increased talkativeness
Less sleep
Hypersexuality
Mild spending sprees/other types of
reckless/irresponsible behaviour
Increased sociability
Overfamiliarity
Mania - ICD-10:
What else can come with mania?
Main symptom
How long does this have to last for it to be classed as full blown mania?
Mania with/without psychosis
Elevated/irritable mood
(at least 1 wk)
Mania - ICD-10:
List criteria where you’d pick 3 or more to diagnose?:
- What 3 moods can they present with?
- Cognition - 5
- Behaviour - 5
- Psychotic symptoms - 2
Irritability Euphoria Lability - rapid, often exaggerated changes in mood, where strong emotions or feelings ------- Grandiosity Distractibility/poor concentration Flight of ideas/racing thoughts Confusion Lack of insight ------- Rapid speech Hyperactivity Less sleep Hypersexuality - Increased libido Reckless behaviour (e.g. spending, sex) --------- Delusions Hallucinations
What does mixed affective episode mean?
Mania and depression which may rapidly alternate
Aetiology:
Biological:
- The main one
- Which meds can cause it? - 2
- What illicit drugs can cause it? - 2
What are some organic causes:
- old age - 2
- thyroid - 1
- brain - 1
What should be done first to in the elderly with sudden onset mania?
Genetics - FH
Anti-depressants
Steroids
Amphetamines
Cocaine
Delirium
Dementia
Hyperthyroidism
Encephalitis
CT scan
Aetiology:
Psychological:
Emotional deprivation and childhood abuse
Certain personality types and belief systems
Aetiology:
Social
Lower social class Unemployed Poor social support Shift work/sleep disruption Alcohol/substance misuse ****** Living in urban areas Lack of relationships Adverse life events especially bereavement
DDx of mania:
Schizoaffective disorder - what is it?
What other disease may cause unstable mood especially in children?
Schizoaffective disorder is a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania.
The mania will improve with Rx however, the psychotic symptoms will remain
ADHD - Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness.
Investigations:
The MDQ and YMRS are self-reported scales. What do they stand for?
What 2 other self-reported scales are used for depression if they present that way? ////////////
HAMD, MADRS and QIDS-C are used by the doc to assess severity. What do they stand for?
Mood disorders questionnaire
Young mania rating scale
Beck scale QIDS-SR - Quick Inventory of Depressive Symptomatology (QIDS) ///////// Hamilton Depression Rating Scale Montgomery and Asberg Scale
Quick Inventory of Depressive Symptomatology, including the Clinician-Rated
Investigations for organic causes or co-morbidities:
Bloods and why?
How to test for illicit drugs?
How to test neurologically? - 3
FBC - raised WBC - infection - encephalitis
TFTs - hyperthyroidism
CRP - inflammation - encephalitis
Also glucose, lipids, U+E, calcium and LFTs
Drug screen - urinary
CT head, MRI and EEG
Biological management of acute mania or hypomania:
What should be done if patient is already receiving Rx? - 3
What should be stopped if they are taking it?
Check adherence
Check drug levels and adjust the dose
Taper and stop any antidepressants
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Antidepressants as they make it worse
