Bipolar disorder Flashcards
(115 cards)
1
Q
Point prevalence of bipolar disorder
A
1.5%
2
Q
Average age of onset of bipolar disorder
A
18-20
3
Q
Increased risk of suicide among people with bipolar disorder compared to the general population
A
15-18x higher
4
Q
Lifetime prevalence of bipolar I
A
1.0%
5
Q
Lifetime prevalence of bipolar II
A
1.1%
6
Q
Lifetime prevalence of subsyndromal bipolar spectrum
A
2.4%
7
Q
Differences between bipolar I and bipolar II
A
Bipolar I has one or more manic or mixed episodes and typically has recurrent depressive episodes
Bipolar II must have at least one hypomanic episode and at least one depressive episode
8
Q
Description of bipolar III
A
Recurrent depression with hypomania occurring only with antidepressants or other treatment
9
Q
Percentage of patients with bipolar disorder who were previously misdiagnosed as having depression
A
40%
10
Q
Stability of a bipolar diagnosis
A
70-91%
11
Q
Average length of time to recover from a treated episode of mania
A
4-5 weeks
12
Q
Percentage of patients with bipolar who show predominantly either depression or mania
A
56%
13
Q
Of patients with bipolar who show polarity in their symtpoms, percentage who show mainly depressive symptoms
A
60%
14
Q
Of patients with bipolar who show polarity in their symtpoms, percentage who show mainly manic symptoms
A
40%
15
Q
Percentage of patients with bipolar who complete suicide
A
10-19%
16
Q
Percentage of patients with bipolar who attempt suicide
A
25-35%
17
Q
Percentage of suicide attempts in patients with bipolar which occur in the depressed phase
A
80%
18
Q
Percentage of patients with bipolar who have a recurrence in the year following a mood episode
A
50%
19
Q
Type of bipolar where patients experience more depressive symptoms
A
Bipolar II
20
Q
Biggest predictor of relapse for patients with bipolar
A
Residual symptoms
21
Q
Index mood disorder in bipolar that leads to patients spending less time unwell
A
Mania
22
Q
Term for antidepressant induced mania
A
Switch
23
Q
Term for when antidepressants over time increase the long-term frequency of manic episodes
A
Mood destabilisation
24
Q
Percentage of patients with bipolar who show antidepressant switch
A
20-40%
25
Risk factors for antidepressant switch in patients with bipolar
Previous antidepressant induced mania
Bipolar family history
Exposure to multiple antidepressants
Initial illness beginning in adolescence or young adulthood
26
Features of bipolar depression compared to unipolar depression
Bipolar depression shows less anxiety, fewer physical complaints, hypersomnia, more withdrawal, and more atypical symptoms
27
Definition of rapid cycling bipolar disorder
4 or more episodes within a year
28
Definition of ultra-rapid cycling bipolar disorder
4 or more episodes within a month
29
Definition of ultra-ultra-rapid cycling bipolar disorder
Switches within one day on four or more days per week
30
Percentage of patients with bipolar who are rapid cyclers
20%
31
Percentage of patients with rapid cycling bipolar disorder who are women
80%
32
Clinical features of rapid cycling compared to standard bipolar disorder
Earlier onset of illness in rapid cycling
More severe depression and mania in rapid cycling
Lower global functioning in rapid cycling
33
Risk factors for rapid cycling
Hypothyroidism
Poor response to lithium
Younger age of onset
Substance misuse
34
Most commonly prescribed medications associated with secondary mania
Corticosteroids
L-dopa
35
Number of days of symptoms required for a diagnosis of mania
7 days
36
Number of days of symptoms required for a diagnosis of hypomania
4 days
37
First line treatment in a first episode of mania
Antipsychotics - haloperidol, olanzapine, quetiapine, or risperidone
38
Treatment for a first episode of mania if the patient is on antidepressants
Consider stopping the antidepressant
Treat with an antipsychotic regardless of whether the antidepressant is stopped
39
First line treatment in an episode of mania where the patient is known to have bipolar and is already on a mood stabiliser
Increase the dose of the mood stabiliser
40
Treatment options in an episode of mania where the patient is known to have bipolar
Increase the dose of the mood stabiliser (first line)
Augment the mood stabiliser with an antipsychotic if taking lithium or valproate
If already taking an antipsychotic - augment with lithium or valproate
ECT
41
When to consider ECT in an episode of mania where the patient is known to have bipolar
Severely unwell patients
Treatment-resistant mania
Patient preference
Pregnant women
42
Psychotropic with the highest risk of hyponatraemia
Carbamazepine
43
First line treatments for bipolar depression
Psychological intervention
Fluoxetine combined with lithium
Quetiapine monotherapy
44
Second line medication for bipolar depression
Lamotrigine - can be used in combination or as monotherapy
45
NICE recommendations for when to use long term maintenance management for patients with bipolar
After a manic episode with significant risk or adverse consequences
Bipolar I when there have been two manic episodes
Bipolar II when there is significant functional impairment or risk
46
First line treatment for long term maintenance of bipolar disorder
Lithium
47
Benefits of lithium therapy in bipolar disorder
Prevents manic and depressive relapse - more effective in preventing mania
Reduces risk of suicide
48
Mood stabilisers which are more effective against manic than depressive episodes
Lithium
Valproate
49
Mood stabilisers which are more effective against depressive than manic episodes
Lamotrigine
50
Antipsychotics which can be used as maintenance therapy in bipolar disorder
Olanzapine
Quetiapine
51
Treatment options for mixed episodes in bipolar disorder
Should be treated as manic episodes
52
Mood stabiliser with the best evidence for mixed episodes
Valproate
53
Treatment for rapid cycling bipolar
Treat hypothyroidism and substance misuse if present
Discontinue antidepressants
Consider lithium, valproate, and lamotrigine
54
Number of years maintenance therapy should be continued for patients with bipolar disorder
At least 2 years
At least 5 years if the patient has risk factors for relapse
55
Antidepressant class with the highest risk of causing a switch
TCAs
56
Length of time antidepressants should be continued in bipolar depression
3-4 months
57
Triad of symptoms seen in antidepressant associated chronic irritable dysphoria in patients with bipolar disorder
Irritability
Middle of the night insomnia
Dysphoria
58
Antiepileptics with no use for treatment of mania
Vigabatrin
Topiramate
Phenytoin
59
Side effects of vigabatrin
Psychosis
Visual field defects
60
Visual side effects of topiramate
Diplopia
Acute myopia
Angle closure glaucoma
61
Benzodiazepine with the best evidence base for use in acute mania
Clonazepam
62
Most effective medication to reduce suicidality in patients with bipolar disorder
Lithium
63
Percentage of patients diagnosed with depression who convert to a diagnosis of bipolar each year
0.3-4%
64
Percentage of patients diagnosed with depression who convert to a diagnosis of bipolar within five years
8-14%
65
Best intervention for acute lithium toxicity with neurological features
Haemodialysis
66
Percentage of middle aged women taking lithium who experience hypothyroidism
20%
67
Percentage of people taking lithium who develop a tremor
25%
68
Frequency of dosing of lithium with the highest risk of polyuria
Twice daily dosing
69
Parathyroid issue rarely caused by lithium
Hyperparathyroidism
70
Evidence based psychotherapies for bipolar disorder
Family therapy
CBT
Psychoeducation
Interpersonal and social rhythms therapy
71
Mood stabiliser which interferes with oral contraceptives
Carbamazepine
72
Male:female ratio for bipolar I
1:1
73
Male:female ratio for bipolar II
1:1.3
74
Mood stabiliser most likely to cause thrombocytopaenia
Sodium valproate
75
Initial treatment options for maintenance therapy in bipolar disorder
Lithium
Valproate
Olanzapine
Quetiapine
76
First line mood stabiliser in hepatic impairment
Lithium
77
Mood stabilisers contraindicated in severe hepatic impairment
Sodium valproate
Gabapentin
78
Mood stabiliser relatively contraindicated in renal impairment
Lithium
79
Interaction between aminophylline and lithium
Lithium levels reduced
80
Mood stabiliser which can exacerbate psoriasis
Lithium
81
Sex more likely to experience mixed affective states in bipolar disorder
Women
82
Percentage of patients who have had a single manic episode who go on to have recurrent mood episodes
90%
83
Features of cyclothymic disorder
Multiple mood episodes over a period of two years
Both high and low moods
Episodes do not meet criteria for either depression or hypomania/mania
84
Length of time a manic episode needs to last for
One week
Any duration if hospitalisation is required
85
Length of time a hypomanic episode needs to last for
4 days
86
Number of additional symptoms required for a diagnosis of a manic episode as well as mood
3
4 if the mood is irritable rather than elevated
87
Additional symptoms which suggest an episode of mania
Grandiosity
Flight of ideas
Decreased sleep
Increased talking
Distractability
Increase in goal directed activity
Psychomotor agitation
Involvement in activities with potential for painful consequences
88
Interaction between sodium valproate and lamotrigine
Valproate increases lamotrigine levels >2x
89
Interaction between oral contraceptive and lamotrigine
Oral contraceptive decreases lamotrigine levels by half
90
Rate of serious rash related to lamotrigine therapy
0.08-0.13%
91
Length of time over which lithium therapy should be stopped
One month
92
Klerman's bipolar subtype I
Mania with depression
93
Klerman's bipolar subtype II
Hypomania with depression
94
Klerman's bipolar subtype III
Cyclothymia
95
Klerman's bipolar subtype IV
Antidepressant induced mania or hypomania
96
Klerman's bipolar subtype V
Depression in a patient with a family history of bipolar disorder
97
Klerman's bipolar subtype VI
Mania without depression
98
Frequency lithium levels should be monitored in a healthy patient established and stable on therapy
Every 6 months
99
Patient groups who should have lithium levels monitored every three months
Older patients
Impaired renal function
Impaired thyroid function
Raised calcium levels
Poor control or adherence
Last level >0.8
Taking NSAIDs
100
Frequency with which TFTs should be checked for a patient on lithium
Six monthly
101
Uses for lithium
Acute treatment in mania
Prophylactic treatment in bipolar disorder
Augmentation in depression
Aggressive and self mutilating behaviour
Steroid induced psychosis
To raise WCC in patients on clozapine
102
Investigations which should be done before lithium is commenced
U&Es
ECG
TFTs
FBC
BMI
103
Timing of lithium medication preferred
Once daily at night
104
Optimum level for lithium when used in acute mania for a young, healthy patient
0.8-1mmol/L
105
Treatment best tolerated in patients with acute mania
Olanzapine
106
Eye sign in severe lithium toxicity
Downbeat nystagmus
107
ECG changes seen in lithium toxicity
T wave flattening
Prolonged QTc
108
Mood stabiliser which causes bleeding gums
Carbamazepine
109
Interactions between lithium and ECT
Increased risk of delirium
Prolonged seizures
Toxic lithium levels
Prolonged neuromuscular blockade
110
First line treatment for long term maintenance of bipolar disorder in renal impairment
Sodium valproate
111
Length of time a driving license should be suspended after one episode of mania
3 months
112
Length of time a driving license should be suspended after an episode of mania, if the patient has had 4 or more episodes in the past year
6 months
113
Anti epileptic drug which can lower transaminases
Vigabtrin
114
Condition most associated with reverse neurovegetative symptoms
Bipolar depression
115
Examples of reverse neurovegetative symptoms
Hyperphagia
Hypersomnia
