BPAD Flashcards
How long should maintenance treatment be continued?
At least 2 years after an episode of bipolar disorder or up to 5 years if the person has risk factors for relapse
How long to treat following first episode mania?
6 months
What medication has been shown to reduce the incidence of suicide in patients with bipolar affective disorder?
Lithium
What is the best treatment option for BPAD with renal impairment?
Sodium valproate
Which symptom is most likely in a patient with severe and acute lithium toxicity?
tremors
What is the most common ECG finding in a patient with acute lithium toxicity?
T wave flattening
What is the point prevalence of BPAD?
1.5%
What is the mean age of onset for BPAD 1 and BPAD 2?
- 18
2. 20
What is the suicide risk for patients with BPAD compared to the general population?
15-18x higher
According to NICE, what proportion of patients with BPAD have one or more a comorbid mental health conditions?
2/3
What is the Akiskal and Pinto classification system for BPAD (1999)?
BPAD 1 = manic depressive illness
BPAD 1.5 = depression with protracted hypomania
BPAD 2 = depression with spontaneous hypomanic episodes
BPAD 2.5 = depression superimposed on cyclothymic temperament
BPAD 3 = recurrent depression + hypomania, occurring solely in association with antidepressant or other somatotherapy
BPAD 3.5 = mood swings that persist beyond stimulant or alcohol abuse
BPAD 4 = depression superimposed on a hyperthymic temperament
Is there a prodrome for BPAD?
Yes, predominantly insidious prodrome seen in > half of patients
What percentage of patients with BPAD are initially misdiagnosed with unipolar depression?
40%
What is the median time taken to recover from a manic episode?
4-5 weeks
What proportion of BPAD patients display a pattern of predominant polarity?
55%
60% predominant depression, 40% predominant mania or hypomania
What clinical features are common to BPAD with depressive polarity (1/3 of all patients)?
Usually BPAD2 Onset often with depressive episode More seasonality More suicide attempts More exposure to antidepressants Better response to lamotrigine long term
What clinical features are common to BPAD with depressive polarity (1/4 of all patients)?
Usually BPAD1 Onset often with mania Less seasonal More substance abuse Better response to antipsychotics long term
What is the suicide rate among patients with diagnosed BPAD?
10-19%
1/4 will attempt suicide at some point
When is risk of recurrence especially high?
In the first year after a mood episode
What are the indicators of relapse?
Residual symptoms (biggest predictor)
First presentation of depression (index phase)
Sleep disruption (?final common pathway)
Comorbidities (physical and mental health)
What is a ‘switch’ in BPAD?
An antidepressant induced mania which occurs within 2 months of commencing the antidepressant
What are the risk factors for antidepressant induced switch?
Previous antidepressant induced manias
FHx of BPAD
Exposure to multiple antidepressant trials
Initial illness beginning in adolescence/young adulthood
How do we differentiate between unipolar and bipolar depression?
Unipolar: More anxiety More somatic complaints Less withdrawal Less psychomotor slowing Insomnia Less atypicality
Bipolar: Less anxiety Fewer somatic complaints More withdrawal More psychomotor slowing Hypersomnia More atypical symptoms
How many mood episodes must a patient have in a year to meet the criteria for rapid cycling?
> 4 episodes per year
(>4 per month = ultra rapid cycling)
*mood episodes are more severe in rapid cycling
