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Psychiatry > Mania > Flashcards

Mania Flashcards

1
Q

what are the different types of causes of mania?

A

neurological condition or injury
precipitators
medications

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2
Q

what are the different neurological condition or injurys that can lead to mania?

A

stroke, trauma, HIV, MS, porphyria, epilepsy

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3
Q

what are the precipitators to mania?

A

o Life factors that lead to early morning waking
o Positive life events
o Negative life events
o Pregnancy, CVA – anything that affects frontal love or cortical structures
o Thyroid disease, alcohol, cannabis

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4
Q

what are the different types of medication that can lead to mania?

A 
antidepressants
other psychotropic medications
anti-parkinsonian
CVS drugs
Respiratory drugs 
Anti-infection 
analgesics
GI drugs
Steroids
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5
Q

what are the psychotropic medications that can cause mania?

A

benzodiazepines, olanzapine, risperidone, lithium, carbamazepine, valproate, gabapentin, fenfluramine, amfetamine, dexamfetamine, methylphenidate, disulfiram

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6
Q

what are the anti-parkinsonian medications that can cause mania?

A

amantadine, bromocriptine, levodopa, procyclidine.

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7
Q

what are the CVS drugs that can cause mania?

A

captopril, clonidine, digoxin, diltiazem, hydralazine, methyldopa withdrawal, procainamide, propranolol, reserpine.

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8
Q

what are the respiratory drugs that can cause mania?

A

aminophylline, ephedrine, salbutamol, terfenadine, pseudoephedrine.

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9
Q

what are the anti-infection drugs that can cause mania?

A

anti-TB medication, chloroquine, clarithromycin, dapsone, isoniazid, zidovudine.

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10
Q

what are the analgesics that can cause mania?

A

buprenorphine, codeine, indometacin, nefopam (IM), pentazocine, tramadol

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11
Q

what are the GI drugs that can cause mania?

A

cimetidine, metoclopramide, ranitidine

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12
Q

which steroids can cause mania?

A

ACTH, beclometasone, corticosteroids, cortisone, dexamethasone, DHEA, hydrocortisone, prednisolone, testosterone.

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13
Q

which other drugs can cause mania?

A

baclofen, cyclizine, ciclosporin, interferon

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14
Q

what does a PET scan in mania show?

A

excessive post synaptic dopamine 2 activity

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15
Q

what neurotransmitters are increased in mania?

A

serotonin and noradrenaline

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16
Q

what chemicals are also raised in mania?

A

inositol phosphate, cortisol

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17
Q

what is the clinical summary of mania?

A

an elated mood lasting 1-2 weeks (or more), with psychotic symptoms

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18
Q

what is the clinical summary of hypomania?

A

no psychotic symptoms, and generally, it does not last as long. Must last >4 days to be classed as hypomania

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19
Q

What is the part A of the mania criteria?

A

Mood must be predominantly elevated, expansive or irritable, and definitely abnormal for the individual concerned. The mood change must be prominent and sustained for at least 1 week (unless it is severe enough to require hospital admission)

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20
Q

what is part B of the mania criteria?

A

At least three of the following signs must be present (four if the mood is merely irritable), leading to severe interference with personal functioning in daily living

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21
Q

what are the signs that make up the criteria for mania?

A
  1. Increased activity or physical restlessness;
  2. Increased talkativeness (‘pressure of speech’);
  3. Flight of ideas or the subjective experience of thoughts racing;
  4. Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances;
  5. Decreased need for sleep;
  6. Inflated self-esteem or grandiosity;
  7. Distractibility or constant changes in activity or plans;
  8. Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving;
  9. Marked sexual energy or sexual indiscretions
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22
Q

what are the features of mood in a MSE of mania?

A

elated, irritable

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23
Q

what are the features of thought in a MSE of mania?

A

fast, sentences may be logical, but linked by puns and similar sounding words, and not by ideas, patient may be very self important and have grandiose ideas.

24
Q

what are the features of perception in a MSE of mania?

A

Hallucinations

25
Q

what are the features of cognition in a MSE of mania?

A

distractibility

26
Q

what are the features of appearance in a MSE of mania?

A

bright coloured clothes, eccentric

27
Q

what are the features of behaviour in a MSE of mania?

A

over friendly, perhaps inappropriate

28
Q

what are the features of speech in a MSE of mania?

A

fast, and difficult to interrupt

29
Q

what are the psychotic symptoms that may be present in mania?

A 
grandiose ideas
persecutory delusions
pressured speech
violent behaviour
self neglect
catatonic behaviour
total loss of insight
30
Q

what is part A of the criteria for hypomania?

A

A. the mood is elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days

31
Q

what is part B of the criteria for hypomania?

A

B. At least three of the following signs must be present, leading to some interference with personal functioning in daily living:

32
Q

what are the additional signs of hypomania?

A
  1. increased activity or physical restlessness
  2. increased talkativeness
  3. difficulty in concentration or distractibility
  4. decreased need for sleep
  5. increased sexual energy;
  6. mild spending sprees, or other types of reckless or irresponsible behaviour;
33
Q

what is the 1st line management of acute mania?

A

Atypical Antipsychotic

Consider lorazepam for agitation management

34
Q

what is the 2nd line management for acute mania?

A

valproate, lamotrigine, lithium

ECT?

35
Q

what speed of referral is required for mania?

A

mania or severe depression urgent referral, hypomania routine referral

36
Q

what is the definition of bipolar?

A

Chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression

37
Q

what age group commonly develop bipolar?

A

late teen years

38
Q

what is the changes in activation of the brain structures involved in bipolar disease?

A

decreased activation and reduced grey matter in areas associated with emotional regulation, and increased activation in ventral limbic brain regions that mediate and generate emotional responses.

39
Q

what is the role of glutamate in bipolar disease?

A

increase in epinephrine and norephinerine

40
Q

what is the additional pathophysiology of bipolar disease?

A

DA and 5-HT
disruption of Ca2+ regulation by neurological insults - excessive glutaminergic transmission or ischaemia
Disruption of hypothalamic–pituitary–adrenal axis via hormone imbalance

41
Q

what is the ICD-10 criteria for bipolar disease?

A

Requires at least 2 episodes, one of which must be hypomanic, manic, or mixed, with recovery usually complete between episodes. Criteria for depressive episodes are the same as unipolar depression Separate category (manic episode) for hypomania or mania (with or without psychotic symptoms) without history of depressive episodes. Cyclothymia included with dysthymia in persistent mood disorders section.

42
Q

what is the DSM-IV criteria for bipolar I?

A

there is underlying depression, interspersed with episodes of mania (usually occur in the ratio 1:1, met criteria for mania)

43
Q

what is the DSM-IV criteria for bipolar II?

A

Current or past hypomanic episode and current or past depressive episode, has never met criteria for manic episode

44
Q

what is the DSM-IV criteria for bipolar II 1/2?

A

depressions superimposed on cyclothymic temperament

45
Q

what is the DSM-IV criteria for bipolar III?

A

Hypomanic episodes only occur following use of antidepressants for depression

46
Q

what is the DSM-IV criteria for bipolar IV?

A

Depressions arising from a hyperthymic temperament

47
Q

what is the DSM-IV criteria for cyclothymic disorder?

A

symptoms not severe enough to class as bipolar, not as low lows, not as high highs, cycle lasts at least 2 years

48
Q

how is mania managed in bipolar disease?

A

same as acute mania
1st Line - Atypical anti-psychotics +/- Lorazepam
2nd Line - valproate, lamotrigine, lithium
ECT?

49
Q

how are depressive episodes in bipolar disease managed?

A

1st line - Atypical antipsychotic

ECT

50
Q

what is the role of antidepressants in bipolar disease?

A

AVOID ANTIDEPRESSANTS – SSRIs preferrable and alongside antipsychotic, lithium or valproate

51
Q

what is the 1st line managed for general maintenance of bipolar disorder?

A

Lithium Carbonate

52
Q

what should be added to bipolar management for recurrent depression?

A

add atypical antipsychotic or lamotrigine

53
Q

what should be added to bipolar management for recurrent mania?

A

add atypical antipsychotics or valproate

54
Q

what should be added to bipolar management for rapid cycling patients?

A

Clozapine

55
Q

what is the criteria for mixed episodes in bipolar disorder?

A

The occurrence of both manic/hypomanic and depressive symptoms in a single episode, present every day for at least 1wk (DSM-IV) or 2wks (ICD-10)

56
Q

what are the typical presentations of mixed episode bipolar disease?

A

o depression plus over-activity/pressure of speech;
o mania plus agitation and reduced energy/libido;
o dysphoria plus manic symptoms (with exception of elevated mood);
o rapid cycling (fluctuating between mania and depression—4 or more episodes/yr)

Psychiatry (11 decks)

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