Bipolar Illness Flashcards
What is another name for bipolar affective disorder
What is it?
In severe cases, there may be severe thought disturbances and psychotic symptoms.
• Between these highs and lows, patients usually experience periods of full remission.
True or false
Bipolar affective disorder (commonly known as manic depression)
It involves periods of deep, prolonged and profound depression alternate with periods of excessively elevated and/or irritable mood known as mania.
Lifetime prevalence: 0.3 – 1.5%
• No significant racial differences
• Age range: 15 – 50+yrs (peaks at 15 – 19yrs and 20 – 24yrs; 21yrs)
• Morbidity and mortality rates are high, in terms of lost work, lost productivity, effects on marriage (increased divorce rates) and the family
• Attempted suicide in 25 – 50%, and completed suicide in 10%
• There are often significant comorbidities esp. drug/alcohol misuse and anxiety disorders (which both increase risk of suicide)
True or false
Bipolar illness is a milder form of
Mania (hypomania) true or false
What is the sub clinical presentation of it
What is rapid cycling
What are mixed states
True
True
There is also a subclinical presentation – cyclothymia – in which an individual may experience oscillating high and low moods, without ever having a significant manic or depressive episode.
Rapid cycling – involves 4 or more episodes of depression or mania in a year
• Symptoms of depression and mania can occur at the same time called mixed states
Manic episodes feature a profound mood disturbance, characterized by ?
The disturbance is sufficiently severe to impair occupational and social functioning
• Manic episodes can present with or without psychotic symptoms
True or false
elation, irritability, or expansiveness (referred to as gateway criteria) of at least 1 week (or severe enough to warrant hospitalization).
•
How is mania diagnosed
- At least 3 of the following symptoms must also be present, 4 if the mood is merely irritable
- Increased activity or physical restlessness;
- Increased talkativeness (‘pressure of speech’);
- Flight of ideas or the subjective experience of thoughts racing;
- Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances;
- Decreased need for sleep;
- Inflated self-esteem or grandiosity;
- Distractibility or constant changes in activity or plans;
- Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving;
- Marked sexual energy or sexual indiscretions.
Hypomanic episodes are characterized by ?
Difference between mania and hypomania
elevated, expansive, or irritable mood of at least 4 consecutive days’ duration.
•
The difference between mania and hypomania being that,
• Hypomanic symptoms are not severe enough to cause marked impairments
in social or occupational functioning or to necessitate hospitalization • And are not associated with psychosis
How is hypomania diagnosed
- At least three of the following must be present, leading to some interference with personal functioning in daily living:
- Mild elevated, expansive, or irritable mood • increased activity or physical restlessness;
- increased talkativeness;
- difficulty in concentration or distractibility; • decreased need for sleep;
- increased sexual energy;
- mild spending sprees, or other types of reckless or irresponsible behaviour; • increased sociability or over-familiarity.
Depressive symptoms lasting for at least 2 weeks
• Presentation same as what prevails in unipolar depression
True or false
How is depression diagnosed by bipolar illness
General Criteria - (ICD-10)
• Depressive episode should last for at least 2 weeks.
• There have been no hypomanic or manic symptoms sufficient to meet the criteria for hypomanic or manic episode at any time in the individual’s life.
• The episode is not attributable to psychoactive substance use or to any organic mental disorder.
• Depression may be mild, moderate or severe
What are the Somatic/Vital/Endogenomorphic/Melancholic/ Biological Symptoms of depression
- Loss of emotional reactivity
- Diurnal mood variation (depression worse in the morning)
- Anhedonia
- Early morning wakening (about 2hrs or more before usual time)
- Psychomotor agitation or retardation
- Loss of appetite and weight (about 5% or more of body weight in past month)
- Loss of libido
Name some core symptoms A and core symptoms B of depression
Core Symptoms A (ICD-10)
• At least 2 of the following 3 symptoms must be present:
• Depressedmoodtoadegreethatisdefinitelyabnormalfortheindividual, present for most of the day and almost everyday, largely uninfluenced by circumstances, and sustained for at least 2 weeks.
• Anhedonia
• Decreasedenergyorincreasedfatiguability
Core Symptoms B (ICD-10)
• Lossofconfidenceandselfesteem
• Unreasonable feelings of self-reproach or excessive and inappropriate guilt
• Recurrentthoughtsofdeathorsuicide,oranysuicidalbehaviour
• Complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation
• Change in psychomotor activity, with agitation or retardation (either subjective or objective)
• Sleepdisturbanceofanytype
• Changeinappetite(decreaseorincrease)withcorrespondingweightchange
• * A fifth character may be used to specify the presence or absence of “ the somatic syndrome”
What are the psychotic symptoms in severe depression
- Psychotic Symptoms in Severe Depression (ICD-10)
- Delusions or hallucinations other than those listed as typically schizophrenic (i.e. delusions other than those that are completely impossible or culturally inappropriate and hallucinations that are not in third person or giving a running commentary); the commonest examples are those with depressive, guilty, hypochondriacal, nihilistic, self-referential, or persecutory content.
- Depressive stupor
- A fifth character may be used to specify whether the psychotic symptoms are mood congruent or mood incongruent
What is mixed episode in bipolar illness
- The current episode is characterized by either a mixture or a rapid alternation (i.e. within a few hours) of hypomanic, manic and depressive symptoms.
- Both manic and depressive symptoms must be prominent most of the time during a period of at least two weeks.
- There has been at least one well authenticated hypomanic or manic episode, depressive or mixed affective episode in the past.
What is cyclothymia
period of at least two years of instability of mood involving several periods of both depression and hypomania, with or without intervening periods of normal mood.
• None of the manifestations of depression or hypomania during such a two-year period should be sufficiently severe or long lasting to meet criteria for manic episode or depressive episode (moderate or severe); however, manic or depressive episode(s) may have occurred before, or may develop after, such a period of persistent mood instability.
In cyclothymia During at least some of the periods of depression at least three of the following should be present
Name them
During at least some of the periods of depression at least three of the following should be present:
(1) A reduction in energy or activity;
(2) Insomnia;
(3) Loss of self confidence or feelings of inadequacy;
(4) Difficulty concentrating;
(5) Social withdrawal;
(6) Loss of interest or enjoyment in sex and other pleasurable activities; (7) Less talkative than normal;
(8) Pessimistic about the future or brooding over the past.
In cyclothymia During at least some of the periods of mood elevation ,at least three of the following should be present
Name them
During at least some of the periods of mood elevation at least three of the following should be present:
(1) Increased energy or activity;
(2) Decreased need for sleep;
(3) Inflated self esteem;
(4) Sharpened or unusually creative thinking; (5) More gregarious than normal;
(6) More talkative or witty than normal;
(7) Increased interest and involvement in sexual and other pleasurable activities;
(8) Over-optimism or exaggeration of past achievements.
What are poor prognostic factors in the prognosis of bipolar illness
POOR PROGNOSTIC FACTORS • Poor employment history • Alcohol abuse • Psychotic features • Depressive features between periods of mania and depression • Evidence of depression • Male sex • Treatment non-compliance
