Bipolar Disorder and Severe Depression Flashcards
Name the three stages/feelings people with BPD feel.
Mania
Euthymia
Depression
Describe the mood, behaviour and thoughts during mania.
Mood - expansive, euphoric, elevated, irritable
Behaviour – increased energy, decreased sleep, extravagant, recklessness
Thoughts - racing, grandoise, unable to concentrate
What is euthymia?
Normal
Describe the mood, behaviour and thoughts of a depressive stage in BPD.
Mood: low, empty, depressed, hopeless
Behaviour: decreased appetite, decreased energy, insomnia
Thoughts: loss of interest/pleasure, suicidal thoughts, negative rumination
List the three components to look at when diagnosing a mood spectruum disorder.
1 - mood elevation component
2 - mood lowering component
3 - duration/frequency of mood swings
*** Revise criteria for diagnosis of BPD
When is BPD usually diagnosed (age)
BP1 - 18 years
BP 2 - 18-34 years
What is the pathophysiology of bipolar disorder?
Unknown
High genetic loading
Polygenetic with individual modest effect sizes
List the environmental risk factors for BPD.
Stress/life events
Absence of close relationships
Altered schedules/shift work
List the medical conditions/treatments that are risk factors for BPD.
Thyroid over or underactivity
Drugs (steroids, interferons)
Chronic illness
Anemia
List the psychological risk factors for BPD.
Self-image/personality
Ruminative thinking
Other DSM 5 diagnoses
Loss events
List the non-drug treatments for BPD.
Education
- about disorder/treatment
- about stable lifestyle routines
- about early warning signs of impending episode and method for managing impending episode through rescue medication
Case Management
- careful review of symptoms each clinic visit
-careful review of side effects
- life charting of previous episodes, daily mood diary
Social/Psychological
- specific psychological therapies (CBT), psychoeducation
-self-help and support groups
How do we manage acute mania
Hospitalization may be necessary - low stimulus environment, boundary setting, supervised medication, prevention of suicide
Drug therapy
- Mood stabilizer (Li or Valproate) plus
- Antipsychotic (e.g. risperidone, olanzapine) and/or
- Benzodiazepine (e.g. diazepam, clonazepam)
Downtitrate neuroleptic/BDZ as manic symptoms resolve q
How do we manage bipolar depression?
Antidepressant should be used alongside mood stabilizer (Lithium)
- risk of only antidepressant = induce mania, induce rapid cycling
What do we use for bipolar maintenance therapy?
Prophylaxis is needed if 2 or more manic or depressive episodes in 5 years
Lithium is first choice
Describe the mood of severe depression.
Intense, unremitting apprehension and morbid statements, blunted emotional response, nonreactive mood, pervasive anhedonia (loss of pleasure)
Describe what psychomotor disturbance happens in melancholic depression.
Retardation (slowed thought, speech, movement) or agitation (motor restlessness)
Describe what other aspects occur in melancholic depression.
Cognitive impairment: decreased concentration and memory
Vegetative dysfunction: interrupted sleep, decreased appetite/weight, dinural variation (especially worse in AM)
Psychosis is often present - delusions and hallucinations
What is thought to cause psychotic depression?
Hypercortisolemia (high cholesterol)
Which age does PD usually affect?
Likelihood increases with age > 45 years
What is the treatment for melancholic depression/PD?
Hospitalization
Antidepressant and antipsychotic combination
ECT
