Bipolar Disorder and Severe Depression

Question 1

Name the three stages/feelings people with BPD feel.

Answer 1

Mania
Euthymia
Depression

Question 2

Describe the mood, behaviour and thoughts during mania.

Answer 2

Mood - expansive, euphoric, elevated, irritable
Behaviour – increased energy, decreased sleep, extravagant, recklessness
Thoughts - racing, grandoise, unable to concentrate

Question 3

What is euthymia?

Answer 3

Normal

Question 4

Describe the mood, behaviour and thoughts of a depressive stage in BPD.

Answer 4

Mood: low, empty, depressed, hopeless
Behaviour: decreased appetite, decreased energy, insomnia
Thoughts: loss of interest/pleasure, suicidal thoughts, negative rumination

Question 5

List the three components to look at when diagnosing a mood spectruum disorder.

Answer 5

1 - mood elevation component
2 - mood lowering component
3 - duration/frequency of mood swings

Question 6

*** Revise criteria for diagnosis of BPD

Question 7

When is BPD usually diagnosed (age)

Answer 7

BP1 - 18 years

BP 2 - 18-34 years

Question 8

What is the pathophysiology of bipolar disorder?

Answer 8

Unknown
High genetic loading
Polygenetic with individual modest effect sizes

Question 9

List the environmental risk factors for BPD.

Answer 9

Stress/life events
Absence of close relationships
Altered schedules/shift work

Question 10

List the medical conditions/treatments that are risk factors for BPD.

Answer 10

Thyroid over or underactivity
Drugs (steroids, interferons)
Chronic illness
Anemia

Question 11

List the psychological risk factors for BPD.

Answer 11

Self-image/personality
Ruminative thinking
Other DSM 5 diagnoses
Loss events

Question 12

List the non-drug treatments for BPD.

Answer 12

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

Question 13

How do we manage acute mania

Answer 13

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

Question 14

How do we manage bipolar depression?

Answer 14

Antidepressant should be used alongside mood stabilizer (Lithium)
- risk of only antidepressant = induce mania, induce rapid cycling

Question 15

What do we use for bipolar maintenance therapy?

Answer 15

Prophylaxis is needed if 2 or more manic or depressive episodes in 5 years
Lithium is first choice

Question 16

Describe the mood of severe depression.

Answer 16

Intense, unremitting apprehension and morbid statements, blunted emotional response, nonreactive mood, pervasive anhedonia (loss of pleasure)

Question 17

Describe what psychomotor disturbance happens in melancholic depression.

Answer 17

Retardation (slowed thought, speech, movement) or agitation (motor restlessness)

Question 18

Describe what other aspects occur in melancholic depression.

Answer 18

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

Question 19

What is thought to cause psychotic depression?

Answer 19

Hypercortisolemia (high cholesterol)

Question 20

Which age does PD usually affect?

Answer 20

Likelihood increases with age > 45 years

Question 21

What is the treatment for melancholic depression/PD?

Answer 21

Hospitalization
Antidepressant and antipsychotic combination
ECT