3. Bipolar Affective Disorders Flashcards
What are the symptoms of mania/bipolar disorder?
Mania (must be present for at least 1w) = I DIG FASTER
- Irritability
- Disinhibited (sexual, social, spending)
- Increased libido
- Grandiose delusions
- Flight of ideas
- Activity/Appetite increased
- Sleep decreased
- Talkative
- Elevated mood
- Reduced concentration
Depression = fatigue, anhedonia, low mood
Psychotic = delusions, hallucinations
What are the ADRs of lithium?
COMMON
- GI upset
- Fine tremor
- Polyuria/polydipsia
- Weight gain
- Metallic taste in mouth
- Ankle oedema
Hypothyroidism
Hyperparathyroidism and resultant hyperCa
Nephrogenic DI
Precipitation of a relapse if discontinued suddenly
***Need to monitor blood levels closely
How should a pt on lithium be monitored?
***BEFORE: U+Es, preg test, TFT, ECG
Li+ levels 12h after first dose, then weekly until dose constant (0.6-0.8mmol/L) for 4w, then monthly for 6m, then every 3m
U+Es, TSH every 6m
Define cyclothymia
Mild periods of elation/depression
Early onset/chronic course
Common in relatives of BPD
Define dysthymia
Chronic low mood not fulfilling the criteria of depression
What is a DDx for mood disorder?
Mood disorders: hypomania, mania, mixed ep, cyclothymia
Psychotic disorder: schizo
Sec: hypo/hyperthyroid, cushings, cerebral tumour
Drug related: amphetamines, cocaine, withdrawal, SE of corticosteroids
Personality disorder: histrionic, EUPD
What are the possible causes of mood disorders?
Biological = genetic, brain illness, physical illness
Psychological = childhood, view of yourself and the world, personality traits
Social = work, housing, finance, relationships, support
What conditions fall under the umbrella term ‘mood disorders’?
Depression
Dysthymia
Cyclothymia
Bipolar disorder
Anxiety disorders
How should BAD be managed?
Full risk assessment + ask about driving: DVLA has guidelines
ACUTE MANIA: (Antidepressants NOT in bipolar)
- SGA = quetiapine 1st line in bipolar
- Benzo = lorazepam
- Anticonvulsant = Na valproate (teratogenic), lamotrigine (SJS)
ACUTE DEPRESSION:
- Lamotrigine (SJS)
- Olanzapine plus fluoxetine
- Quetiapine
LONG-TERM: Li
ECT (if severe depression, other Tx not effective, life threatening, catatonia, suicide risk, stupor, severe psychomotor retardation)
Psychological = psychoeducation, CBT, IPT, psychodynamic, mindfulness, focus of education of early warning signs (sleep changes)
Social interventions = family, housing, finance, employment, coping strategies
Outline the pathophysiology of bipolar affective disorder
Monoamine hypothesis = elevated mood as a result of increased central monoamines (NA + serotonin)
Dysfunction of the HPA axis (abnormal secretion of cortisol - as found in unipolar depression), and dysfunction of the hypothalamic-pituitary-thyroid axis may contribute
How should suspected mania be investigated?
Mood disorder questionnaire
Bloods: FBC, TFT (hyper/hypo), U+E (with view to start lithium), LFT (with view to start mood stabilisers), glucose, Ca
Urine drug test
CT head: rule out SOL
Outline the ICD-10 Dx of mania and BAD
Mania = 3/9
- grandiosity
- dec sleep
- pressure of sleep
- flight of ideas
- distractibility
- psychomotor agitation
- reckless behaviour
- loss of social inhibition
- marked sexual energy
Bipolar = at least 2 ep in which the pts mood/activity level are significantly disturbed (one of which MUST be mania or hypomania)
What is mood affective state?
Characterised by either a mixture or rapid alternation (usually within a few hours) of hypomanic, manic, and depressive Sx
