bipolar Flashcards
bipolar disorder mood cycling
mania
hypomania - mild form of mania
normal mood
mild depression
major depression
define bipolar and its types
bipolar affective disorder (BPAD) - known as manic (high) depression (low)
- disorder that affects mood swings - can swing from one extreme to the other
BPAD type 1 - at least 1 manic or mixed episode, may experience depressive episodes
type 2 - hypomania + major depressive episodes
pathology and symptoms of mania
pathology - increased dopamine + noradrenaline, decreased GABA
symptoms - reduced sleep, agitation, grandiosity, excessive pleasure seeking, flight of ideas, psychosis, loss of conc.
manic episode doesn’t last long - eventually person burns out - few days upto a week
pathology and symptoms of depression
pathology - decreased dopamine
symptoms - loss of conc., anhedonia, reduced appetite, early morning wakening, low mood
bipolar treatment?
involves treatment of manic element with mood stabilisers + antipsychotics
- antipsychotics used in smaller doses than SCZ - better tolerated
1st line treatment of mania - lithium, olanzapine, quietapine, risperidone
2nd line - valproic acid
prophylaxis - lithium + olanzapine
- if unresponsive to lithium - prophylaxis = carbamazepine
difference b/w bipolar and unipolar depression
not as simple to treat
bipolar depression is more severe than unipolar
- associated with higher risk of suicide
if using antidepressants only on bipolar patients - risk of them switching and becoming manic - so use SSRI + mood stabiliser for acute ep not for prophylaxis
treatment of bipolar depression
NICE guidelines:
1st line - fluoxetine + olanzapine or quietapine
2nd - lamotrigine on its own OR + olanzapine or quietapine or lithium
3rd - increase lithium to max dose
maudsley guidelines:
1) quietapine
2) lithium and valproate
3) add lamotrogine
4) antidepressant + mood stabiliser or antipsychotic
