wamss notes mood disorders: bipolar Flashcards by Monica Palumbo

mania

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

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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

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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)

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acronym to remember additional symptoms of mania

DIGFAST

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subtypes of mania

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

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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

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hypomania

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

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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

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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

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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

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bipolar affective disorder type 2

Hypomanic and depressive episodes

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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

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criteria for bipolar affective disorder type 2

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

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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

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risk factors for bipolar

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

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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

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