spectrum disorder Flashcards
what is the annual incidence of bipolar disorder
Bipolar presents in a variety of ways and is recurrent; treatment provides control but not a cure. Lifetime incidence is 1% and annual incidence is 4,500. Bipolar usually presents under 30.
what are the different sub categories of bipolar disorder
Acute mania – episode runs over a short course
Mixed affective disorder – manic & depressive episodes occur simultaneously, or within a short space of time
Rapid cycling – 4 episodes experienced in 12 months
Unipolar depression – only depression experienced
how long does mania last for
episodes can last 2 weeks-4 months, occurring less frequently than depression
what is meant by hypomania
elevated mood, but not quite manic state normal affect
how long does depression last
episodes may last 6-12 months
what is meant bye depression
Depressive episodes are associated with the disruption of noradrenaline, dopamine, serotonin & glutamate systems.
what are manic epsisodes due to
Manic episodes may be due to a hyperdopaminergic state, depletion of GAGA & excess of glutamate.
those who have bipolar disorder have an increased concentration of what?
Those with bipolar have a greater concentration of neurons in the Locus Coeruleus, responsible for arousal/ alertness and, via mesolimbic projections, have a role to play in motivation, drive and response to stress.
what is meant by bipolar 1
Characterised by at least one manic episode and one or depressive episodes, where manic episodes dominate. Affect both sexes equally.
what is meant by bipolar 2
Characterised by one or more major depressive episodes, accompanied by at least one hypomanic episode - depressive episodes dominate. The risk of suicide is highest during depressive episode. Higher prevalence in females.
what is meant by bipolar 2
Characterised by one or more major depressive episodes, accompanied by at least one hypomanic episode - depressive episodes dominate. The risk of suicide is highest during depressive episode. Higher prevalence in females.
how do you diagnosis bipolar disorder
•Distinct period of abnormal mood for more than 7 days
•Depressive symptoms: Lowered mood, anergia (abnormal lack of energy), anhedonia (loss of capacity to experience pleasure i.e. where pleasure was previously felt in a certain activity, pleasure is no longer found), weight changes, insomnia, suicidal ideation
•Manic symptoms: euphoric, expansive or irritable, with 3 or more associated features present to a significant degree:
oIncreased self-esteem
oGrandiosity
oIncreased, aberrant speech
oPsychomotor agitation/ overactivity
oFlight of ideas/ racing thoughts
oPleasure seeking
oReduced need for sleep – this is the perception of patients, not the physiological reality
oReduced ability to concentrate
what are the rating scales
Rating scales can be used to confirm diagnosis, asses severity, establish a baseline and monitor a response to treatment.
- Mood Disorder Questionnaire (MDQ.)
- Young Mania Rating Scale (YMRS)
- Montgomery Asperg Depression Rating Scale (MADRS)
what is the prognosis of bipolar disorder
In a 12-year follow up, patients with BPAD were found to be symptomatic for almost half of their lives (47%); the most common complaint at this time was depression (32%); mania or hypomania was reported in 9% of patients.
Mortality is high, due to the likelihood of self-neglect, accidental death via risk-taking behaviour. Mixed Affective Disorders are noted to be the most disabling and have the highest suicide rate of all sub sets of BPAD. Lifetime risk of death by suicide in BPAD estimated at 19%. Annually, around 0.4% of patients with BPAD commit suicide; international average suicide rate of 0.017%.
what is the treatment of bipolar disorder
There is no cure for BPAD; the aim of treatment is to manage symptoms of mania & depression, preventing relapse, and to minimise side effects to enhance compliance.
what is the first line treatment for bipolar disorder
lithium
what is the concentration of lithium given for the treatment of bipolar disorder
• 0.4–1.2 g PO OD or BD. Adjust dose according to serum-lithium concentration, doses are initially divided throughout the day, but OD administration is preferred when serum-lithium concentration stabilised (0.4 and 1 mmol/L).
describe how lithium works in the treatment of bipolar disorder
• Interacts with the transport of monovalent or divalent cations in neurons. Lithium has been shown to change the inward and outward currents of glutamate receptors (especially GluR3), acting to keep the amount of glutamate active between cells at a stable, healthy level
what are the side effects of lithium in the treatment of bipolar disorder
• Tremor, muscle weakness, nausea/vomiting, increased urination, excess thirst
what should you do if there is signs of toxicity in lithium in the treatment of bipolar disorder
• Signs of toxicity require withdrawal of treatment and include increasing gastro-intestinal disturbances (vomiting, diarrhoea), visual disturbances, polyuria, muscle weakness, fine tremor increasing to coarse tremor, CNS disturbances (confusion and drowsiness increasing to lack of coordination, restlessness. With severe overdose, seizures, cardiac arrhythmias (including sino-atrial block, bradycardia and first-degree heart block), blood pressure changes, circulatory failure, renal failure, coma and sudden death reported.
what are the interactions associated with lithium for the treatment of bipolar disorder
• Lithium may enhance the neurotoxic effect of TCAs and antipsychotic agents. Lithium may decrease the serum concentration of Antipsychotic Agents. Lithium may enhance the adverse/toxic effect of Tramadol. The risk of seizures may be increased and serotonin syndrome risk. NSAIDs may increase the serum concentration of Lithium. Opioid Agonists & SSRIs: serotonin syndrome. Sodium Chloride (salt): May increase the excretion of Lithium. Caffeine may decrease the serum concentration of Lithium.
what should be monitored when a patient is taking lithium for the treatment of bipolar disorder
• Renal and thyroid function should be monitored, and blood tests should be taken to monitor serum lithium levels – taken 12 hours after dose.
what are the contraindications of lithium in the treatment of bipolar disorder
- Care should be taken in elderly, impaired renal/thyroid function, poor symptom control/adherence, high plasma lithium level
- Lithium causes heart defects in foetus if given during pregnancy (Ebstein’s anomaly)
what is the dose for valproate
• 1–2 g daily; therapeutic plasma conc of 30-100 μg/mL. To prevent major seizures, valproate should not be discontinued abruptly, as this can precipitate status epilepticus