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Psychiatry 2023 > wamss notes mood disorders: bipolar > Flashcards

wamss notes mood disorders: bipolar Flashcards

1
Q

mania

A

A state of abnormally elevated arousal and energy levels with labile affect

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2
Q

criteria for mania

A

A. Abnormally persistently elevated, expansive or irritable mood & persistently increased
goal-directed activity or energy. Lasting at least 1week, nearly every day
B. 3 of the following must also be present
- Distractibility
- Indiscretion (engagement in activities potential for harm)
- Grandiosity
- Flight of Ideas
- Activity Increase or Goal-directed activity ↑
- Sleep Deficit (↓ need for sleep)
- Talkativeness (pressured speech)
C. Mood disturbance severe enough to cause marked impairment in social or occupation or to
necessitate hospitalisation to prevent harm to self or others or there are psychotic features
D. Not attributable to the effects of a substance or medical condition

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3
Q

additional symptoms present during mania

A
  • Distractibility
  • Indiscretion (engagement in activities potential for harm)
  • Grandiosity
  • Flight of Ideas
  • Activity Increase or Goal-directed activity ↑
  • Sleep Deficit (↓ need for sleep)
  • Talkativeness (pressured speech)
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4
Q

acronym to remember additional symptoms of mania

A

DIGFAST

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5
Q

subtypes of mania

A

Psychotic or Non-Psychotic
Irritable or Euphoric
Depressive
Rapid Cycling…

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6
Q

symptoms of mania

A

Often described as euphoric, excessively cheerful, high or feeling on top of the world
Unlimited and haphazard enthusiasm for interpersonal, sexual or occupational interactions
Rapid shifts in moods from euphoria, dysphoria & irritability; mood lability
Engagement in multiple overlapping new projects
Inflated self esteem

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7
Q

hypomania

A

Same features as Mania but does not inflict the same amount of impairment

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8
Q

criteria for hypomania

A

A. Abnormally persistently elevated, expansive or irritable mood & persistently increased goal-directed activity or energy for at least 4 consecutive days
B. Same as above
C. Episode is associated with unequivocal change in functioning
D. Disturbance in mood & change in function are observable by others
E. Episode is not severe enough to cause marked impairment in functioning

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9
Q

cyclothymic disorder

A

At least 2 years there are numerous periods with hypomanic Sx that do not meet the criteria for hypomania or &
numerous periods with depressive Sx that do not meet the criteria for a major depressive episode
Sx are present for at least half of the time & pt has not been Sx free for >2months

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10
Q

bipolar affective disorder type 1

A

Psychiatric diagnosis characterised by abnormally elevated or irritable mood episode(s) accompanied by disruptive symptoms of distractibility, indiscretions, grandiosity, flight of
ideas, hyperactivity, decreased need for sleep, and talkativeness
Used to be known as Manic Depressive Illness

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11
Q

bipolar affective disorder type 2

A

Hypomanic and depressive episodes

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12
Q

criteria for bipolar affective disorder type 1

A

Criteria met for at least 1 Manic Episode

Often preceded by or followed by Hypomania or Major Depressive Episodes

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13
Q

criteria for bipolar affective disorder type 2

A

Criteria for current or past Hypomanic Episode and criteria for Major Depressive Episode

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14
Q

symptoms of bipolar

A

mania
depression is the most common presentation
30-40% time MD Phase
30-40% time Euthymic Phase
20-30% time Manic Phase

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15
Q

risk factors for bipolar

A

Family Hx of bipolar or suicide
Other mental illness
Drugs (PKD, corticosteroids)

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16
Q

DDx bipolar disorder

A
  • Substance abuse
  • Depression
  • Schizophreniform disorder
  • Hypomania
  • ADHD, BPD, psychosis
  • Organic- Hyperthyroidism
17
Q

investigations for bipolar

A

Exclude organic & other causes:
FBC, ESR, B12/folate, U&Es, LFTs, TFTs, glucose, Ca+, TFTs
Other targeted investigations- MRI, ANA, syphilis

18
Q

first line treatment for bipolar

A

First Line
Mood Stabilisers – Lithium #1 – takes 7-14 days
Atypical Antipsychotics – faster onset of action - Olanzapine, Quetiapine, Lorazedone-

19
Q

second line treatment for bipolar

A

Second Line
Other Mood stabilisers or Antipsychotics

20
Q

prophylaxis for bipolar

A

Mood Stabilisers
First Line
Lithium #1
Sodium Valproate, Lamotrigine
Second Line
Antipsychotics
Third Line
Mood Stabiliser + Atypical Antipsychotic
Treatment Refractory
Clozapine
ECT + Mood Stabilisers & Antipsychotics

21
Q

medical cessation in bipolar

A

94% pts will have another manic or depressive episode without treatment. Most require ongoing management

22
Q

remission of bipolar is when

A

3 months symptom free

23
Q

bipolar is resolved when

A

2 years symptom free

24
Q

treatment during the first episode of mania

A

Tx for at least 6 months of symptom free
relapse likely

25
Q

treatment for bipolar depression

A

treatment for at least 12 months of symptom free

26
Q

should you treat bipolar depression with antidepressants

A

no

27
Q

non-phamracologicall treatment of bipolar

A

Highly genetic cause but still a role for non-pharmacological management
Psychoeducation
Family
CBT – good for mania & depression
SW – support, accommodation, education, finance
Treatment of comorbid conditions

28
Q

prognosis of bipolar

A

95% pts have another manic episode without Tx
90-95% Respond to treatment
Treatment resistant bipolar is rare

29
Q

bipolar depression

A

Depressive episode that occurs prior to or with episodes of mania
Often the presenting complaint in pts with bipolar – evident before the manic phase

30
Q

what is the difference between bipolar depression and major depression

A
  • More acute onset
  • Often shorter episodes
  • Often younger onset with bipolar depression
  • Sleep & appetite are generally less predominant symptoms
  • Lack of energy a prominent symptoms
  • Often symptoms of Depression with Atypical Features
  • Psychotic symptoms
31
Q

treatment of bipolar depression

A

Do not treat with Antidepressants
- Manic switch
- Limited evidence for efficacy of ADs in manic depression
First Line:
- Mood Stabilisers – Lithium & Lamotrigine #1
Second Line:
- Antipsychotics- Quetiapine, Olanzapine, Risperidone- approved
if Treatment Resistant: Add an Antidepressant

32
Q

first line of treatment for bipolar depression

A

Mood Stabilisers – Lithium & Lamotrigine #1

33
Q

why shouldnt you treat bipolar depression with antidepressants

A
  • Manic switch
  • Limited evidence for efficacy of ADs in manic depression
34
Q

prognosis of bipolar depression

A

Many pts go into sub-syndromic depression with functional impairment
Treat depression for at least 8-12 months Sx free

35
Q

criteria substance/medication-induced bipolar related disorder

A

A. Prominent & Persistent disturbance in mood that predominates & is characterised by elevated, expansive or irritable mood with or without depressed mood
B. There is evidence of:
- Sx developed during or soon after substance intoxication or withdrawal
- The substance is capable of producing the Sx
C. Disturbance is not better explained by bipolar or a related disorder

Psychiatry 2023 (21 decks)

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