wamss notes mood disorders: bipolar Flashcards
mania
A state of abnormally elevated arousal and energy levels with labile affect
criteria for mania
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
additional symptoms present during mania
- 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)
acronym to remember additional symptoms of mania
DIGFAST
subtypes of mania
Psychotic or Non-Psychotic
Irritable or Euphoric
Depressive
Rapid Cycling…
symptoms of mania
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
hypomania
Same features as Mania but does not inflict the same amount of impairment
criteria for hypomania
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
cyclothymic disorder
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
bipolar affective disorder type 1
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
bipolar affective disorder type 2
Hypomanic and depressive episodes
criteria for bipolar affective disorder type 1
Criteria met for at least 1 Manic Episode
Often preceded by or followed by Hypomania or Major Depressive Episodes
criteria for bipolar affective disorder type 2
Criteria for current or past Hypomanic Episode and criteria for Major Depressive Episode
symptoms of bipolar
mania
depression is the most common presentation
30-40% time MD Phase
30-40% time Euthymic Phase
20-30% time Manic Phase
risk factors for bipolar
Family Hx of bipolar or suicide
Other mental illness
Drugs (PKD, corticosteroids)
DDx bipolar disorder
- Substance abuse
- Depression
- Schizophreniform disorder
- Hypomania
- ADHD, BPD, psychosis
- Organic- Hyperthyroidism
investigations for bipolar
Exclude organic & other causes:
FBC, ESR, B12/folate, U&Es, LFTs, TFTs, glucose, Ca+, TFTs
Other targeted investigations- MRI, ANA, syphilis
first line treatment for bipolar
First Line
Mood Stabilisers – Lithium #1 – takes 7-14 days
Atypical Antipsychotics – faster onset of action - Olanzapine, Quetiapine, Lorazedone-
second line treatment for bipolar
Second Line
Other Mood stabilisers or Antipsychotics
prophylaxis for bipolar
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
medical cessation in bipolar
94% pts will have another manic or depressive episode without treatment. Most require ongoing management
remission of bipolar is when
3 months symptom free
bipolar is resolved when
2 years symptom free
treatment during the first episode of mania
Tx for at least 6 months of symptom free
relapse likely
treatment for bipolar depression
treatment for at least 12 months of symptom free
should you treat bipolar depression with antidepressants
no
non-phamracologicall treatment of bipolar
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
prognosis of bipolar
95% pts have another manic episode without Tx
90-95% Respond to treatment
Treatment resistant bipolar is rare
bipolar depression
Depressive episode that occurs prior to or with episodes of mania
Often the presenting complaint in pts with bipolar – evident before the manic phase
what is the difference between bipolar depression and major depression
- 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
treatment of bipolar depression
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
first line of treatment for bipolar depression
Mood Stabilisers – Lithium & Lamotrigine #1
why shouldnt you treat bipolar depression with antidepressants
- Manic switch
- Limited evidence for efficacy of ADs in manic depression
prognosis of bipolar depression
Many pts go into sub-syndromic depression with functional impairment
Treat depression for at least 8-12 months Sx free
criteria substance/medication-induced bipolar related disorder
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
