Bipolar Affective Disorder Flashcards
What is the definition of bipolar disorder?
An episodic mood disorder associated with mood disturbances, including mania, hypomania, and depression.
What is the typical age onset for bipolar disorder?
Late teens, early 20s
What does a family history of bipolar disorder typically result in?
Earlier onset and precipitated by lower levels of stress
What are some risk factors for bipolar disorder?
Family history
Comorbid substance abuse/psychiatric disorder
Pattern of psychosocial instability
How does bipolar I present?
Severe manic episodes that often result in impaired functioning and hospital admission
How does bipolar II present?
Hypomanic episodes interspersed with depressive episodes
What is the most common form of bipolar disorder?
Bipolar II
What is the ICD-11 criteria for a hypomanic episode?
Elevated/irritable mood that is abnormal for the individual and lasting for at least 4 consecutive days.
At least three present:
- Increased activity or physical restlessness
- Increased talkativeness
- Difficulty in concentration or distractibility
- Decreased need for sleep
- Increased sexual energy
- Mild spending sprees, or other types of reckless or irresponsible behaviour
What is the ICD-11 criteria for a manic episode?
Elevated/irritable/expansive mood that is abnormal for the individual and lasting for at least 1 week (unless hospital intervention).
At least three present that are causing severe interference with daily functioning:
- Increased activity or physical restlessness
- Increased talkativeness (‘pressure of speech’)
- Flight of ideas or the subjective experience of thoughts racing
- Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances
- Decreased need for sleep
- Inflated self-esteem or grandiosity
- Distractibility or constant changes in activity or plans
- Behaviour which is foolhardy or reckless and whose risks the subject does not recognise e.g. spending sprees, reckless driving
- Marked sexual energy or sexual indiscretions
What signs might be seen on a mental state exam of a patient with bipolar disorder?
Appearance and behaviour: bright clothes, distractibility, overfamiliarity
Speech: increased talkativeness (hard to interrupt), punning and clang associations
Thoughts: increased flow (racing thoughts), flight of ideas (discernible links between topics that the patient jumps between), grandiosity
What are some differentials for bipolar disorder?
Substance induced mood disorders
Psychotic disorders
Personality disorders
OCD
ADHD
What is the management of an acute manic episode?
First line: atypical antipsychotic e.g. olanzapine, quetiapine or risperidone
Second line: valproate, lamotrigine, or lithium
Benzodiazepines or Z-drugs can be used for symptom control e.g. agitation and insomnia
What is the management of an acute bipolar depression?
First line: atypical antipsychotic e.g. quetiapine or olanzapine
Antidepressants usually avoided (can cause rapid cycling mood)
- Antidepressants should not be prescribed without an anti-manic drug
- Avoid antidepressants in those with a recent manic/hypomanic episode or history of rapid cycling
- SSRIs (particularly fluoxetine) may be suitable in some cases
What is the management for bipolar maintenance?
Lithium is gold standard (+ valproate if primarily manic/hypomanic)
If the patient does not want regular monitoring: various combinations or sole use of valproate, quetiapine and olanzapine
Psychoeducation is very important (good evidence for group psychoeducation)
What are some complications of bipolar disorder?
Suicide
Lithium toxicity
Treatment related weight gain
Cognitive dysfunction
Disability
