MOOD DISORDERS (BIPOLAR AND ECT) Flashcards
What is hypomania?
persistant mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency.
Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection.
Absence of psychotic symptoms
Requires symptoms to last 4 days
What is mania?
Mood is elevated out of keeping with the patient’s circumstances and may vary from carefree joviality to almost uncontrollable excitement.
Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep.
Attention cannot be sustained, and there is often marked distractibility.
Self-esteem is often inflated with grandiose ideas and overconfidence.
Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character.
Symptoms lasting 7 days
What psychotic symptoms typically occur in mania with psychotic symptos?
delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present, or the excitement, excessive motor activity, and flight of ideas are so extreme that the subject is incomprehensible or inaccessible to ordinary communication.
What is bipolar affective disorder?
A disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of hypomania/mania and on others of depression. Repeated episodes of hypomania or mania only are classified as bipolar.
Episodes of depression are not required for a diagnosis of bipolar affective disorder but are common
What are symptoms and signs of BAD that distinguish it from depression?
Hypersomnia, lability, and weight instability - experienced by ~90% of people with bipolar disorder and ~50% of people with unipolar depression
Earlier age of onset (peak age 15 to 19 years)
Abrupt onset (possibly triggered by stressor).
More frequent episodes of shorter duration.
Comorbid substance misuse.
Higher post-partum risk.
Psychosis, psychomotor retardation, and catatonia.
Lower likelihood of somatic symptoms.
FHx is more likely in bipolar
What are the types of bipolar affective disorder?
Current episode hypomanic
Current episode manic without psychotic symptoms
Current episode manic with psychotic symptoms
Current episode mild or moderate depression
Current episode severe depression without psychotic symptoms
Current episode severe depression with psychotic symptoms
Current episode mixed
Currently in remission
Other bipolar affected disorders
Bipolar affected disorder unspecified
How do you treat bipolar affective disorder mania/hypomania?
Manage mania/hypomania by considering stopping antidepressants and offer an antipsychotic
If antipsychotic isnt suitable offer an alternative
If not suitable offer lithium
If not suitable offer valproate
If not suitable offer ECT
What proportion of those who have a manic episode go on to have further episodes?
> 90%
What is rapid cycling?
4 or more mood episodes within a year
What proportion of pt complete suicide?
10-15%
How do you treat BAD depressive episode?
Quetiapine alone, or
Fluoxetine combined with olanzapine, or
Olanzapine alone, or
Lamotrigine alone
Psychological treatment
How do you manage BAD in the long term,?
Start long-term treatment with lithium to prevent relapses, or
If lithium is not effective, valproate may be added to lithium treatment.
If lithium is poorly tolerated, valproate alone or olanzapine alone may be considered.
This is to prevent relapses and is indicated in those who have has more than 1 episode
Outline the care plan for BAD?
Clear, individualised social and emotional recovery goals.
An assessment of the person’s mental state.
A crisis plan, indicating early warning symptoms and triggers of both mania and depression relapse and preferred response during relapse, including liaison and referral pathways.
A medication plan with a date for review by primary care, frequency and nature of monitoring for effectiveness and adverse effects, and what should happen with medication in the event of a relapse.
An advance statement - a written statement, drawn up and signed when the person is well, which sets out if there are treatments that the person does not wish to receive if they lose their capacity to make decisions for themselves through illness.
A statement of wishes and feelings as to how they would prefer to be treated (or not treated) if they were to become ill in the future, who would be told about the illness or anything else of importance such as financial affairs, care of pets or at-risk relatives (but this is not binding with respect to children).
Key clinical contacts in case of emergency or impending crisis.
Whats the estimated lifetime risk of bipolar in the general public if a first-degree relative suffers from the condition.
5-10 times greater
What do twin studies show about the aetiology of BAD?
monozygotic twin studies show there is a 40-70% risk of developing bipolar if the other sibling suffers from the disorder.
What are the main features of mania?
Elevated mood
Extreme irritability and/or aggression
Increased energy
Restlessness
Decreased need for sleep
Flight of ideas
Racing thought
Pressure of speech
Increase libido and disinhibition
Distractibility, poor concentration
Psychotic features: delusions (fixed belief contradictory to reality or rational argument) or hallucinations
What are the main features of hypomania?
Elevated mood
Irritability
Increased energy
Feeling of physical and/or mental efficiency
Increased sociability
Talkativeness
Over-familiarity
What is a mixed episode in BAD/
rapid alternating between manic and depressive symptoms, or criteria for mania/hypomania and at least three symptoms of depression for ≥1 week, or criteria for a depressive episode and at least three mania/hypomania symptoms for ≥ 2 weeks.
How does ICD10 diagnose BAD?
at least two mood episodes, one of which must be mania or hypomania.
What psychological therapies are offered for BAD?
CBT
