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Psychiatry > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

1
Q

What is bipolar?

A

A mood disorder where you experience manic/hypomanic episodes and depressive episodes

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2
Q

What are the different types of bipolar?

A 
Bipolar disorder type 1
Bipolar disorder type 2
Rapid cycling
Mixed affective
Cyclothymia
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3
Q

What is the difference between bipolar disorder type 1 and 2?

A

Type 1
- At least one episode of mania lasting longer than 1 week with most also having periods of depression, manic episodes generally last 3-6 months untreated and depressive episodes 6-12 months untreated
Type 2
- At least one period of major depression and at least one period of hypomania

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4
Q

What is the difference between mania and hypomania?

A

Hypomania lasts a shorter time and is less severe than mania

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5
Q

What is rapid cycling bipolar?

A

Frequent mood swings

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6
Q

What is mixed affective bipolar?

A

Where both mania and depression are seen in the same episode

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7
Q

What is cyclothymia?

A

Spontaneous swings in mood that are not sufficiently severe or persistent to warrant another diagnosis

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8
Q

What is important to ask in a bipolar history?

A 
How are they currently feeling?
How long have they felt like this?
Questions about mood
Sleep
Appetite
Energy
Memory
Hallucinations
Suicidal thoughts
Self-harm
Reckless behaviour
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9
Q

What factors can increase your risk of having bipolar disorder?

A

Family history
Stressful event or major life changes
Drug abuse

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10
Q

How common is bipolar?

A 
1% lifetime prevalence
Equally common in men and women
No variation in socioeconomic class or race
Mean age of onset is 21
Higher prevalence in divorced people
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11
Q

Name 3 psychiatric differential diagnoses of bipolar disorder

A 
Unipolar depression
Cyclothymia
Schizophrenia/schizoaffective disorder
Anxiety disorder
OCD
ADD
Personality disorder - EUPD
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12
Q

Name 3 drug differential diagnoses of bipolar disorder

A

Acute intoxication with recreational drugs such as amphetamines, MDMA, ecstasy, cocaine
Dopamine antagonist - bromocriptine can mimic mania
Antidepressants
Corticosteroids
Levodopa
Prescribed stimulants

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13
Q

Name 5 organic differential diagnoses of bipolar disorder

A 
Cushing's - mania
Brain disease - progressive frontal lobe dementia, cerebrovascular disease, MS, AIDS, epilepsy, SLE, encephaltitis, space-occupying lesion, stroke
Hyperthyroidism
Addison's disease
Vit B12 deficiency
Renal dialysis
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14
Q

How does mania present?

A

Feeling happy or excited even if things aren’t going well
Being full of new and exciting ideas
Flight of ideas
Hearing voices that others can’t hear
Being more irritable
Feeling much better than normal
Pressure of speech
Easily distracted and can’t focus on one topic
Lack of sleep
Thinking you can do more than you actually can
Disinhibited
Reckless decision making
Overspending, casual sex with different people, using drugs/alcohol, making unwise business decisions

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15
Q

What are the main components of bipolar disorder?

A

Mania/hypomania
Depression
Can have symptoms of psychosis

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16
Q

What is the pathophysiology of bipolar disorder?

A

Biochemical changes - monoamines increased in mania and dexamethasone doesn’t suppress cortisol levels in people with mania suggesting similar pattern of non-suppression seen in severe depression
Possible brain changes

17
Q

What investigations should you do in someone with bipolar disorder?

A 
Physical examination
FBC, U&E, serum creatinine, eGFR
Liver biochemisty
ESR/CRP
TSH
Parathyroid hormone and calcium
EEG/brain scan
18
Q

What biological management should you do for someone with bipolar disorder?

A

For mania - atypical anti-psychotics short course - aripiprazole, valproate, lithium, risperidone
For depression - fluoxetine, olanzapine, lamotrigine
Mood stabilisers - lithium, valproate, olanzapine, quetiapine
Review medication
Physical health reviews
If in manic episode stop anti-depressants

19
Q

What psychological support could you give for someone with bipolar disorder?

A

CBT
Interpersonal therapy
Bipolar support groups

20
Q

What social support could you offer someone with bipolar disorder?

A 
Monitoring of physical health
Employment aid
Advanced statement if lack capacity at any point
CPA
Lifestyle support
Lithium card with them
Avoid dehydration
OT support
Financial support
Protection from exploitation
Risk management
21
Q

What is the prognosis of bipolar disorder?

A

Mean duration of manic episode is 2 months
95% make full recovery in time
Recurrence - 90% relapse within 10 years

22
Q

What risks should you consider in someone in a manic episode?

A

Financial issues
Sexual behaviour
Risk to others - financial, caring obligations
Risk to self - financial, physical health (STDs, doing dangerous activities, lack of food and sleep?), alcohol or drug usage
Who are they now spending time with? Dangerous people?
Risk of exploitation?

Psychiatry (15 decks)

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