Mood Disorders: Bipolar Flashcards
Define Bipolar Affective Disorder
Chronic episodic mood disorder characterised by at least one episode of Mania/Hypomania, followed by a further episode of Mania/Depression
either can occur first
(Includes patients who at presentation have only suffered Mania as all will eventually develop depression)
Describe three potential Biological causes of BPAD
Genetic (40-70% Monozygotic Concordance)
Neurochemical (Increased Dopamine, Increased Serotonin)
Endocrine (Increased Cortisol, Increased Aldosterone, Increased Thyroid)
What are some risk factors for BPAD
Aggressive Spenders
Age in early 20
Anxiety disorders
After depression
Strong family Hx
Substance misuse
Stressful life events
Describe the clinical features of Mania in BPAD
- grandiosity
- decreased sleep
- pressure of speech
- flight of ideas
- distractibility
- psychomotor agitation
- reckless behaviour
- loss of social inhibitions
- marked sexual energy
3 symptoms required for diagnosis
what is required for a diagnosis of bipolar affective disorder?
requires at least two episodes in which a person’s mood and activity levels are significantly disturbed – one of which MUST be mania or hypomania
What should you always screen for in a Depressed patient?
Mania
What is Hypomania?
Mildly elevated/irritable mood for present for at least four days
Symptoms of mania where present are to a lesser extent
Interruption of life but not disruption
May have partial insight
Define Mania without Psychosis
Similar to Hypomania but to a greater extent, with symptoms present for at least a week and complete disruption of work/social activities
Grandiose Ideas, Sexual Disinhibition, reduced sleep may lead to exhaustion
Define Mania with Psychosis
Severely elevated mood or suspicious mood with auditory Hallucinations and grandiose persecutory Delusions
pt may be aggressive
What is the difference between Bipolar I and Bipolar II?
Bipolar I - Periods of severe mood episodes from Mania to Depression
Bipolar II - Milder form of mood elevation, involving milder episodes of Hypomania alternating with Depression
What is Rapid Cycling in BPAD?
More than four mood swings in a 12 month period with no intervening asymptomatic periods
Poor prognosis
treatment with 2 mood stabilisers - lithium, sodium valproate
Describe the ICD10 classification of BPAD
1) Currently Hypomanic
2) Currently Manic
3) Currently Depressed
4) Mixed Disorder
5) In Remission
Describe the expected Appearance, Behaviour, Speech and Mood of a patient with BPAD (MSE)
Appearance - Flamboyant, Heavy makeup/jewellery
Behaviour - Disinhibited, Distractable
Speech - Loud, Fast, High Volume, Puns, Neologisms
Mood - Elated
What are Neologisms?
Creating new words
Describe the expected Thought, Perception, Cognition and Insight of a patient with BPAD (MSE)
Thought - optimistic, pressure of speech, circumstantiality, delusions
Perception - usually don’t have hallucinations, although may have mood congruent auditory hallucinations
Cognition - fully orientated but cognition impaired
Insight - Poor
Name 5 blood tests you would want to carry out if you suspected BPAD
- FBC
- TFTs (for hypo or hyper)
- U&Es (baseline for starting Lithium)
- LFTs (Baseline for mood stabilisers)
- Calcium and Glucose (biochemical disturbance can cause mood symptoms)
Other than bloods, give three other investigations for BPAD
Mood Disorder Questionnaire
Urine Illicit Drug Test - can cause manic symptoms
CT head to rule out SOL
Give differentials for BPAD
Depression
Schizophrenia
Drug Related
When would you hospitalise someone with BPAD?
- Reckless behaviour causing risk to self or others
- Significant Psychotic Symptoms
- Impaired Judgement
- psychomotor agitation
How would you pharmacologically manage the ‘Manic’ phase of BPAD?
1) Antipsychotics - olanzapine, risperidone or quetiapine
2) Mood Stabilisers - lithium
+/- Benzodiazepines
How would you manage the Acute Depressed phase of BPAD?
1) Antipsychotics (normally Olanzepine, either alone or combined with Fluoxetine)
2) Mood Stabilisers - lamotrigine
NO ANTIDEPRESSANTS
What is the long term pharmacological management of BPAD?
Start it 4 weeks after acute episode resolves
Lithium is first line, can add Valproate (the combination is first line for rapid cycling)
The management of BPAD can be described with the mnemonic CALMER. Define it
CBT
Antipsychotic
Lorazepam
Mood Stabiliser
ECT
Risk Assessment
what can be used for an episode of depression in bipolar?
(non-pharmcological)
high intensity psychological intervention eg CBT
describe the bio, psycho, social model for managing bipolar
what is important to ask about when discussing mania and/or depression?
driving - DVLA has guidelines about driving when manic or severely depressed
What is a Pseudodementia?
When depression appears like dementia
How could you ask about mood?
Rate on a scale of 1-10
What are the three components of risk?
Risk to self
Risk to others
Risk from others
what imaging can be done where presentation/examination may be atypical or where there is suspicion of an intracranial lesion
MRI
CT
