Bipolar affective disorder Flashcards
Define bipolar affective disorder.
Manic depression. Involves periods of both depression and mania. May have full return to normal in between. Pattern and frequency of episodes are variable.
Explain the aetiology/risk factors of bipolar affective disorder.
Genetic factors.
Incidence is higher in higher social classes, urban and ethnic minorities.
Increased risk in early post partum.
Recuurrence rate high especially if first episode in adolescence.
Sleep disruption caused by shift work etc may precipitate manic episode.
Summarise the epidemiology of bipolar affective disorder.
Lifetime risk 1%. First episode in early twenties.
What are the three different presenting stages of bipolar affective disorder?
Hypomania
Mania without psychosis
Depression
What are signs of hypomania?
Mild mood elevation
Increased activity/eneergy
Low sleep
Talkative
Overafmiliarty
Increased libido
What are signs of mania without psychosis?
Elated mood
Increased energy
Pressure speech
High creativity/efficiency
Sex disinhibition
Reduced sleep
+ Psychosis: grandiose delusions and auditory hallucinations
How would a bipolar affective disorder patient present?
Appearance: Bright and outlandish/neglected.
Behavior: Overfamiliar/friendly.
Mood: Elated that can be irritable/angry.
Speech: Loud, pressured.
Thought: Grandiose, persecutory delusions.
Perceptions: Hallucinatons, mostly auditory.
What are investigations for bipolar affective disorder?
Exclude other causes: Substance use, SOL, TFT, corticosteroids, anabolic steroids, FBC, U+Es, LFTs, Ca2+, Glucose, Urine drug screen.
What is the acute management for bipolar affective disorder?
Mania
- First line: Olanzapine; Quetiapine; Aripiprazole; Lithium; Valporate
- Second line: Carbamazepine
Depression
- First line: Quetiapine; Lamotrigine
- Second line: Lithium
- Combination therapy
What is the long-term management of bipolar disorder?
No clear evidence-based guidelines
CBT treatment, Suicide prevention
Neuroprotection:
- Lithium
- Valporate
- Lamotrigine
What are the complications associated with bipolar affective disorder? What is the prognosis of bipolar affective disorder?
10% suicide rate, substance misuse, non compliance with prophylaxis leading to relapses, rapid cycling escalation (4+ episodes per year).
Most relapses due to poor compliance. Recovery between episodes is often complete. 90% relapse rate even with good prophylaxis. Median duration of untreated mania is 4 months, followed by depression for 6 months. Manic episodes become less frequent and shorter, whereas depressive ones lengthen.
Poor prognostic factors include: early onset, poor compliance, persistent depressive symptoms, severe mania, non response, comorbid PD, rapid cycling, substance misuse.
