BPAD/Bipolar affective disorder Flashcards
What are the ICD10 BPAD definitons
> 2 episodes, 1 MUST BE MANIC associated (hypomania/mania/mixed) and other can be depressive
Mania must last 4m
Depression 6m
and COMPLETE recovery between both
90% people with mania tend to have depressive episodes
Classification:
Type 1 BPAD – manic episodes interspersed with depressive episodes
Type 2 BPAD – recurrent depressive episodes, with less prominent hypomanic episodes
Rapid cycling BPAD – ≥4 episodes/year (respond to sodium valproate well)
What are the signs and MSE of BPAD
MSE can be the one of depression -
but the MSE of manic episode better
most present during depressive episodes so always ask about mania
A-Excitable, irritable, distracted, innapropriate clothes
S- Pressured speech -> mutism
E- increased self esteem, grandiose, labile, irritable, insomnia, loss of inhbition, appetite up
P- Grandiose delusions, Paranoia, catatonic
T- Flight of idea, racing thought, over-optimism, suicuidal ideas, Sncheiders 1st rank Sx (see shcizophrenia)
I-Minimal
C -nil impact
(can check for decrease need for sleep, food and increased libido)
Classification:
Type 1 BPAD – manic episodes interspersed with depressive episodes
Type 2 BPAD – recurrent depressive episodes, with less prominent hypomanic episodes
Rapid cycling BPAD – ≥4 episodes/year (respond to sodium valproate well)
Define mania and hypomania and mixed
Mania- a distinct period of abnormalluy and persistantly elevated expansive or irrtable mood with >3 characteristic of mania, lasting at least 7 days,
Impair occupational/social functioning +/- psychosis
1st rank sx are not likely to persist past acute episodes (if do -shizophrenia)
Hypomania ->3 characteristics features of mania >4 days - does not impair functioning/no psychosis/delusion
mixed - mixture or rapid alternation (within a few hours) of manic/hypomanic, depressive sx
most present during depressive episodes so always ask about mania
Aetiology and risk factors of BPAD
Biological- genetic -fhx 7x risk
anatomical - decrease grey matter
transmitters- increase NA, DA, Serotonin trigger
psychosocial - stressful life events
Ix of BPAD
Ix - colleteral Hx, phsyical exam, establish baseline state Urine drug screen Bloods- FBC, TSH, UE, LFT, ECG Risk assessment Rating scales- young mania rating scale
most present during depressive episodes so always ask about mania
Management of acute episodes of BPAD
cannot be diagnosed in primary care -alawys refer if sx of hypomania, mania, or severe depression (last 2-urgent to CMHT/admission)
acute mania/hypomania
taper off and stop meidcation (ie SSRI)
Monitor fluid/food
Sedation possible
If NOT on treatment -stablise before starting lithium
1st line-antipschotic (olanzapine> haloperidole/risperidone/Quietapine)
2nd-different antipsychotic (from list above)
3rd - add lithium/sodium valporate
(lithium not great acute-need high dose and risk toxicity)
If ON treatment -
optimise medication, stop antidepressants
check compliance, short term sedatives (BDZ)
Check lithium levels -if normal start atypical
Management of Long term BPAD
4 weeks after acute episode -
1st line -
Lithium alone (monitor levels for toxicity -5w)-every dose change until stable then 3mo then 6mo
if lithium no work -lithium and sodium valporate
if lithium not tolerated - valproate OR olanzapine alone
co-existence with depression -cant use antidepressants alone as can cause switch to mani-only give with mood stablisiser/antipsychotic
1st line -fluoxetine and olanzapine
2nd -quietzapine alone
3- olanzapine or lamotrigine
psych therapy- all through out to improve compliance wih meds (after acute done)
CBT - identify relapse factors, create preventions strategies (routine, lifestyle, good sleep, avoiding stress)
Psychodynamic psychotherapy
social -family support and therapy -can aid return to work/education
Prognosis of BPAD patients
Manic episodes begum abrutplty and are shorter than depressive
reocvery is complete bewteen
Remission become shorter with age and depression more frequent
15% commit suicid w/o treatment (normal on lithium)
