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3018 > Lecture 9 Bipolar > Flashcards

Lecture 9 Bipolar Flashcards

1
Q

phases of bipolar

A

acute stabilisation

ongoing maintenance

relapse prevention

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2
Q

treatment differs based on

A

phase, severity, polarity

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3
Q

DSM-5 criterion A for manic episode

A

-abnormally & persistently elevated expansive or irritable mood
AND
-increased goal directed activity/energy, present nearly daily

Manic:
>= 1 week, present most of the day, nearly every day
OR
any duration if needs hospitalisation

Hypomanic:
>=4 consecutive days, present most of the day, nearly every day

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4
Q

DSM-5 criterion B for manic episode

A
  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. Rapid or pressured speech
  4. Flight of ideas or racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity or psychomotor agitation
  7. Excessive involvement in activities that have a high potential for negative consequences

3 or more needed, 4 if mood is only irritable, present to a significant degree & represent noticeable change from usual behaviour

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5
Q

Other criteria for manic vs hypomanic episodes

A

Manic:
C. mood disturbance sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalisation, or psychotic features
D. episode not attributed to physiological effects of substance or other medical condition

Hypomanic:
C. episode associated with an unequivocal change in functioning that is uncharacteristic of the individual
D. disturbance in mood and change in functioning observable by others
E. episode not severe enough to cause C in manic
F. same as D of manic

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6
Q

Diagnosis of bipolar I vs II

A

Bipolar I:

  • must manic episode
  • hypomanic and major depressive episode not necessary

Bipolar II:

  • must not manic episode
  • both hypomanic and depressive episode
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7
Q

manic to depressive episode ratio in bipolar I

A

manic to depressive 1:3, remission in between

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8
Q

hypomania

A

Less severe than manic episodes:

  • Change in functioning is uncharacteristic of the individual
  • Mood disturbance is noticeable to others

Shorter duration than manic episodes

Not severe enough to disrupt functioning, but can impairfunctioning

Not severe enough to result in hospitalisation

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9
Q

Cyclothymic disorder

A

Chronic, less severe form of bipolar disorder

Numerous cycles of hypomanic and depressive symptoms that are not severe enough to meet criteria for manic or major depressive episodes

Symptoms for at least 2 years, no more than 2 months without symptoms

Symptoms cause distress or impairment in functioning

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10
Q

best treatment for bipolar

A

pharmacological + adjunct psychological interventions

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11
Q

Goal of acute stabilisation

A

reduce arousal, agitation, aggression, behavioural/cognitive disturbance and psychosis

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12
Q

acute stabilisation for mania

A

pharmacotherapy as first line treatment:

1) stabilisation of manic mood->mood stabiliser or antipsychotic mediaction
2) rapid containment of behavioural disturbance ->antipsychotic, short-term benzodiazepine
3) manage cognitive disturbance ->antipsychotic
4) severe or high risk ->ECT

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13
Q

acute stabilisation for hypomania

A

follows general principles of mania

responds to modest doses of pharmacotherapy and psychosocial interventions

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14
Q

acute stabilisation for depression

A

goal: to achieve complete and functional remission of depressive symptoms

contain suicidal risk

pharmacotherapy:

  • monotherapy with 2nd-generation antipsychotics or mood stabiliser
  • combined therapy, the above with antidepressant

treatment emergent affective switch into mania from antidepressant

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15
Q

ECT

A

when medication not viable

effective for acute mania, severe or treatment-resistant depression

confusion, disorientation, memory loss

pharmacotherapy required to maintain mood stability and prevent relapse

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16
Q

components of ongoing maintenance

A

medical: medication monitoring, prophylactic medication to prevent relapse
psychological: CBT, Interpersonal Social Rhythm Therapy, psychoeducation, family-focused therapy

social and lifestyle: support groups, healthy eating, regular exercise

17
Q

Pharmacotherapy maintenance

A

mood stabiliser: lithium

anticonvulsants: lamotrigine
antipsychotics: atypical antipsychotics
antidepressants: SSRI, SNRI

18
Q

medication monitoring

A

Psychiatric review to determine medication regimen, based on

  • Physical examination
  • Tolerability of side effects
  • Efficacy of pharmacotherapy

Monitoring of medication tolerability and toxicity

  • Side effects include weight gain, drowsiness, dizziness, stomach upset, dry mouth and constipation.
  • Long term use can affect kidney, renal, thyroid and cardiac functioning.

Often involves coordinated care across GP and specialists

19
Q

pros and cons of lithium

A

lithium carbonate as first-line treatment for mania and depression
neuroprotective and anti-suicidal properties

toxicity:
narrow theraputic index
toxic at high blood conc.
requires regular monitoring

20
Q

psychological maintenance: CBT

A

more effective for depressive episodes and for people with less severe illness (i.e. fewer past episodes)

Key technique: cognitive restructuring

Patients encouraged to:

  • Monitor symptoms
  • Challenge/change unhelpful thinking
  • Improve medication adherence
  • Foster self-efficacy

Effective in reducing episodes and hospitalisations, improving medication compliance

Mindfulness-based Cognitive Therapy to teach people to become more aware of thoughts and feelings, to relate to them as “mental events’ rather than aspect of self/reflection of reality

21
Q

treatment phases of CBT

A

1) Socialization into cognitive therapy model and development of individualized formulation and treatment goals
- Includes psychoeducation and exploration of interpersonal functioning
- Identifying and challenging negative automatic thoughts
- Developing behavioural experiments

  1. Cognitive and behavioural approaches to symptom management and dysfunctional automatic thoughts
    - Self-monitoring and self-regulation techniques

3.Dealing with cognitive and behavioural barriers to treatment adherence and modifying maladaptive beliefs

  1. Anti-relapse techniques and belief modification
    - Relapse prevention
22
Q

Interpersonal and Social Rhythms Therapy

A

aim: improve interpersonal functioning and to reduce disruption to daily routine and sleep-wake cycles
interpersonal: Addressing losses, role transitions and interpersonal problems

stabilising social rhythms: Fixing wake time across 7 days of the week

23
Q

Psychoeducation

A

aim: improve knowledge about managing the condition and preventing relapse
- Improving awareness of illness
- Treatment adherence
- Harm avoidance
- Detecting early warning signs
- Lifestyle regularity

24
Q

Family-focused Therapy

A

aim: to enhance caregivers’ illness management and self-care. Involves individual with bipolar disorder and their family members

Psychoeducation

  • Addresses symptoms, causes, and treatment of bipolar disorder
  • Medication compliance
  • Coping mechanisms, stigma and emotional impact of bipolar disorder are explored
  • Collaborative relapse-prevention plan

Communication skills

  • Improving active listening
  • Delivering positive/negative feedback

Problem-solving
-Medication non-compliance, social-occupational impairment, previous episodes

25
Q

components of relapse prevention

A

Mood monitoring on daily mood chart

Recognising early warning signs of an episode

Collaborative relapse prevention plan

Coping with stressful events

Preventing manic thinking

Planning hospitalisations in advance when required

26
Q

relapse prevention plan

A
  1. Identify support team
2. Identify early warning signs of an episode
• Depressed thoughts, symptoms
and behaviour
• (Hypo)manic thoughts, symptoms
and behaviour
  1. Take early action if I notice signs of depression or mania
    • Contact support team
    • Maintain regular schedule of sleep, activities and pleasant events
    • Evaluate my thoughts for negative or hyperpositive thinking
    • Talk with my family about ways to cope
    • Limit my alcohol and avoid all nonmedication drugs
  2. Take active steps to keep my mood in desired range
    • Adhere to prescribed medications
    • Adhere to appointment schedule with GP/psychiatrist/psychologist
    • Keep regular sleep schedule and manage stress
    • Discuss communication styles that may reduce my stress with my family
  3. Contact supports in the case of strong suicidal thoughts, keep myself safe until I can be seen, or go to the Emergency Department
  4. If I become depressed/manic, I would like my support team to…

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