Mania, Schizophrenia, Bipolar Flashcards
What is mania?
An extreme mood state with irresponsible actions and grandiose views lasting at least one week to four months unless shortened by an intervention.
What characterizes mania with psychosis?
Mania with features of psychosis, including hallucinations and delusions.
Define hypomania.
A less severe episode of mania with minimal functional impairment, no hospitalization, and no psychosis.
What does DIG-FAST stand for in the context of mania presentation?
- Distractability
- Irresponsible behavior
- Grandiosity with delusions
- Flight of Ideas
- Activity increases
- Sleep decreases
- Talkativeness
What is the typical duration of a manic episode?
1-3 months.
What is a mixed affective disorder?
Characterized by the presence of several prominent manic and several prominent depressive symptoms occurring simultaneously or rapidly alternating.
What are the symptoms of bipolar disorder?
- Anhedonia
- Low mood
- Reduced interest/pleasure
- Reduced energy or fatigue
- Irresponsible behavior
- Grandiose views
- Overactivity and Flight of ideas
List associated symptoms of bipolar disorder.
- Disrupted sleep
- Reduced concentration
- Low self-worth or excessive guilt
- Future hopelessness
- Recurrent thoughts of death
- Significant changes in appetite or weight
- Psychomotor agitation or retardation
What are the ICD-11 classifications of mixed affective disorders?
- Bipolar type I
- Bipolar type II
- Rapid Cycling
- Cyclothymic disorder
What defines Bipolar type I?
More than one manic or mixed episode with/without psychosis, and recurrent depressive and manic or mixed episodes.
What defines Bipolar type II?
One or more hypomanic episodes and at least one depressive episode, with no history of manic/mixed episodes.
What is rapid cycling in bipolar disorder?
> 4 mood swings within a year.
What characterizes cyclothymic disorder?
Persistent affective disorder over ≥ 2 years with hypomania and depressive symptoms that are insufficient for a depressive episode diagnosis.
What are some differential diagnoses for mixed affective disorders?
- Schizoaffective disorder
- Schizophrenia
- ADHD
- Drugs and Alcohol
- Stroke, Multiple Sclerosis, Tumour, Epilepsy
- AIDS, Neurosyphilis
- Endocrine disorders
- Systemic Lupus Erythematosus (SLE)
What is the epidemiology of bipolar disorder?
Males = Females, positive family history, increased forms of depression.
What are common investigations for mixed affective disorders?
- Social: collateral history and old notes
- Medical: U&Es, TFTs, Glucose
Name tools used to measure symptoms of mixed affective disorders.
- SCID
- SCAN
- Young Mania Rating Scale (YMRS)
What is the first-line treatment for an acute manic episode?
Atypical antipsychotic e.g. olanzapine, risperidone, quetiapine, clozapine.
What should be monitored when using atypical antipsychotics?
Be aware of Agranulocytosis.
What are second-line treatments for an acute manic episode?
- Mood Stabilizers e.g.
- Valproate
- Lamotrigine
- Lithium
What is the gold standard treatment for mania?
Lithium.
What are risks associated with lithium during pregnancy?
Risk of Ebstein’s anomaly.
What is the treatment for depressive episodes in mixed affective disorders?
Atypical antipsychotic e.g. quetiapine, olanzapine; if ineffective, add anticonvulsant e.g. lamotrigine or lithium adjunct.
What is the first-line maintenance treatment for bipolar disorder?
Lithium.
What should be done if there are manic or depressive episodes during maintenance treatment?
First add an atypical antipsychotic, and if response is poor, consider anticonvulsants.
What is the recommendation regarding antidepressants in bipolar disorder?
Avoid usage as they can cause rapid cycling mood and mania.
