Bipolar disorder Flashcards
What is bipolar?
A mood disorder where you experience manic/hypomanic episodes and depressive episodes
What are the different types of bipolar?
Bipolar disorder type 1 Bipolar disorder type 2 Rapid cycling Mixed affective Cyclothymia
What is the difference between bipolar disorder type 1 and 2?
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
What is the difference between mania and hypomania?
Hypomania lasts a shorter time and is less severe than mania
What is rapid cycling bipolar?
Frequent mood swings
What is mixed affective bipolar?
Where both mania and depression are seen in the same episode
What is cyclothymia?
Spontaneous swings in mood that are not sufficiently severe or persistent to warrant another diagnosis
What is important to ask in a bipolar history?
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
What factors can increase your risk of having bipolar disorder?
Family history
Stressful event or major life changes
Drug abuse
How common is bipolar?
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
Name 3 psychiatric differential diagnoses of bipolar disorder
Unipolar depression Cyclothymia Schizophrenia/schizoaffective disorder Anxiety disorder OCD ADD Personality disorder - EUPD
Name 3 drug differential diagnoses of bipolar disorder
Acute intoxication with recreational drugs such as amphetamines, MDMA, ecstasy, cocaine
Dopamine antagonist - bromocriptine can mimic mania
Antidepressants
Corticosteroids
Levodopa
Prescribed stimulants
Name 5 organic differential diagnoses of bipolar disorder
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
How does mania present?
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
What are the main components of bipolar disorder?
Mania/hypomania
Depression
Can have symptoms of psychosis
What is the pathophysiology of bipolar disorder?
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
What investigations should you do in someone with bipolar disorder?
Physical examination FBC, U&E, serum creatinine, eGFR Liver biochemisty ESR/CRP TSH Parathyroid hormone and calcium EEG/brain scan
What biological management should you do for someone with bipolar disorder?
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
What psychological support could you give for someone with bipolar disorder?
CBT
Interpersonal therapy
Bipolar support groups
What social support could you offer someone with bipolar disorder?
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
What is the prognosis of bipolar disorder?
Mean duration of manic episode is 2 months
95% make full recovery in time
Recurrence - 90% relapse within 10 years
What risks should you consider in someone in a manic episode?
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?
