BPAD Flashcards
What is Bipolar affective disorder (manic depression)
- Characterised by one episode of mania (or hypomania) followed by a further episode of mania (or hypomania) or depression
- Important: all cases of mania will eventually develop depression
Epidemiology
- Lifetime risk: 1-3%
- W=M
- Higher in BME groups than white population
RFs
- 3As: Age (early 20s), Anxiety disorders, After depression
* 3 Ss: Strong FHx, Substance misuse, Stressful life events
Symptoms
of mania or depression, depends what they present with
What are the severities of mania
hypomania
mania
mania w/ psychosis
Symptoms of hypomania
Mildly elevated mood present for >= 4 days
- Symptoms of mania to lesser extent
- Not severe disruption of work/social life
- Partial insight
Sx of mania
Sx’s present for >1 week
- Complete disruption of social/work life
- Grandiose ideas (not delusions)
- sexual disinhibition
- excessive spending
Sx mania w/ psychosis
- severely elevated or suspicious mood
- Psychotic features: grandiose or persacutory delusions, auditory hallucinations (mood congruent: ‘you’re amazing’ ‘they’re watching you’)
- Aggression
MSE bipolar
Appearance: Flamboyant/unusual combo of clothing, heavy makeup + jewellery, personal neglect when severe condition
Behaviour: Over-familiar, disinhibited (flirtatious, aggressive) ^ psychomotor activity, distractible, restless
Speech: Loud, ^ rate and quantity, pressure of speech, uninterruptable, puns and rhymes, neologisms
Mood: Elated, euphoric and/or irritable
Thought: Optimistic, pressured thought, flight of ides, loosening of association, circumstantiality, tangentiality (person deviates from topic), overvalued ideas, grandiose/persecutory delusions
Perception: Usually no hallucinations. Mood congruent auditory hallucinations may occur
Cognition: Attention + concentration often impaired. Fully orientated
Insight: Very poor
Classification of bipolar
- Bipolar 1: periods of severe mood episodes from mania to depression (one or more manic episodes w/ or w/out hx of depressive episode)
- Bipolar 2: milder form of mood elevation (hypomania) + severe depression (one or more depressive episodes + 1 or more hypomanic episode)
- Rapid cycling: more than 4 mood swings w/in 12month period (no intervening asymptomatic period)
DDx
those of depression, mania and hypomania
Diagnosis
- Remember for any psych condition – there must be NO ORGANIC CAUSE for the Sx’s
- Mania requires 3/9: Grandiosity/inflated self-esteem, decreased sleep, pressure of speech, flight of ideas, distractibility, psychomotor agitation (restlessness), reckless behaviour (spending sprees, reckless driving), loss of social inhibitions, increased libido
- Bipolar Affective Disorder requires two episodes of significant disturbance to person’s mood – one must be mania or hypomania
ICD-10 BPAD
- Currently hypomanic
- Currently manic
- Currently depressed
- Mixed disorder
- In remission
Ix BPAD
- Bloods: FBC, TFTs, U+Es (renal function w/ view of starting lithium), LFTs, glucose, calcium (can cause mood problems)
- Urine drug test: illicit drugs
- CT head: SOL (cause manic symptoms)
- ECG (before treatment)
Rx of acute manic episodes
- 1st line: second generation/atypical anti-psychotics (risperidone) → why not mood stabilisers 1st line? As anti-psychotics have RAPID onset
- 2nd line: mood stabiliser (lithium → sodium valproate)
- Also: BDZs to aid sleep
- Severe/life-threatening manic episode: ECT
