Bipolar Disorder

Question 1

What are affective disorders?

Answer 1

• disorders that affect the way you think and feel

Question 2

In affective disorders terminology what does euthymia mean?

1 - bad mood
2 - upset
3 - angry
4 - normal mood

Answer 2

4 - normal mood

- greek for happy and well

Question 3

In affective disorders terminology what are the 3 disorders of mood we need to be aware of that have a pervasive (an unwelcome influence on our mood or physical effect) that can affect their friends, family etc..?

1 - depression, hypomania, mania
2 - depression, euthymia, mania
3 - depression, hypomania, euthymia
4 - euthymia, hypomania, mania

Answer 3

1 - depression, hypomania, mania

• Depression (low mood)
• Hypomania (elevation of mood)
• Mania (further elevation of mood)

Question 4

In affective disorders terminology Depression, Hypomania and Mania are all disorders of mood that have a pervasive (an unwelcome influence on our mood or physical effect) affect that can affect their friends, family etc. What is common in patients with mood disorders such as these?

1 - free from other illness
2 - co-morbid physical disorders
3 - co-morbid psychological disorders
4 - co-morbid physical and psychological disorders

Answer 4

4 - co-morbid physical and psychological disorders

- metabolic syndrome and anxiety for example

Question 5

What are subsyndromal mood disorders?

1 - mood disorders that are elevated above the diagnostic criteria, such as depression and mania
2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

Answer 5

2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania

Question 6

What is dysthymia?

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

Answer 6

1 - low mood (but not sufficient for diagnosis of depression)

• greek for bad low mood
• chronic low mood

Question 7

What is Cyclothymia? (cyclo looks like cycling)

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

Answer 7

2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis

Question 8

In patients with depression (low mood) and hypomania (elevated mood) what other psychotic disorder can the symptoms present as?

1 - psychosis
2 - schizophrenia
3 - generalised anxiety disorder
4 - phobia

Answer 8

1 - psychosis

Question 9

What is a key feature of bipolar disorder?

1 - period of high elation
2 - periods of high depression
3 - periods of high elation and depression
4 - periods of high elation and euthymia

Answer 9

3 - periods of high elation and depression

• definition is >2 episodes of low mood (depression) and elevated mood (mania)

Question 10

What is the key difference between bipolar disorder 1 and 2?

Answer 10

• bipolar 1 can move across whole spectrum, such as severe psychotic depression and mania
• bipolar 2 can move from psychotic depression to hypomania only

Question 11

When comparing manic vs hypomanic, which has the longer presentation?

Answer 11

• manic = at least 1 week long
• hypomanic = several days

Question 12

When comparing manic vs hypomanic, which has the following presentations?

1 - Elevated or irritable mood/expansiveness
2 - Increased energy
3 - Rapid/pressured speech
4 - Flight of ideas
5 - Increased self-esteem/grandiosity
6 - Decreased need for sleep
7 - Distractibility
8 - Impulsive/reckless behaviour

Answer 12

• mania
• hypomanic may have aspects of these, but generally less severe

Question 13

When comparing manic vs hypomanic, do both have hallucinations and delusions?

Answer 13

• no
• just mania

Question 14

What is the key aspect that determines mania from hypo or mild mania?

1 - volume of patient
2 - intensity of the patient
3 - functional impairment
4 - all of the above

Answer 14

3 - functional impairment

• patient will also experience hallucinations and delusions
• can involve high irritability, self important ideas, poor judgement and disinhibition

Question 15

Bipolar disorders can be:

• mixed = depressive and manic symptoms occur together
• alternating = mania and depression follow one another, rapidly changing
• rapid cycling = mania and depression follow each other, generally separated by a few weeks

Which of these has the highest suicide rates?

Answer 15

• mixed states
• depressive cognitions combined with manic energy are dangerous

Question 16

In patients with bipolar disorder, do men or women liver longer?

Answer 16

• women
• patients die from suicide
• women = live 13 years with 5% suicide
• men = live 9 years with 8% suicide

Question 17

All of the following are differentials for bipolar disorder, EXCEPT which one?

1 - schizophrenia
2 - dementia
3 - endocrine disorder
4 - delirium
5 - stimulant drugs

Answer 17

4 - delirium

• not typically a differentials of bipolar disorder

Question 18

What is the 12 month prevalence of bipolar disorder?

1 - 0.6 - 0.8%
2 - 6 - 8%
3 - 16 - 38%
4 - 46 - 58%

Answer 18

1 - 0.6 - 0.8%

Question 19

What is the lifetime risk of developing bipolar disorder?

1 - 0.1%
2 - 1%
3 - 11%
4 - 21%

Answer 19

2 - 1%

• no difference of risk in genders

Question 20

In patients diagnosed with bipolar disorders, what % are diagnosed before the age of 50 y/o?

1 - 0.9%
2 - 9%
3 - 39%
4 - 90%

Answer 20

4 - 90%

• generally occur in 1st half of life
• before 25 y/o and average is 18 y/o

Question 21

How long do bipolar episodes generally last for?

1 - 3 hours
2 - 3 days
3 - 3 weeks
4 - 3 months

Answer 21

4 - 3 months

• it can vary, but this is the average

Question 22

What % of patients with bipolar disorder will attempt suicide at some point in their lifetime?

1 - 0.5%
2 - 5%
3 - 25%
4 - 50%

Answer 22

4 - 50%

• 10% of those who attempt suicide will be successful
• much higher risk than the general public

Question 23

What % of bipolar disorder has been attributed to genetics?

1 - 0.7%
2 - 7%
3 - 37%
4 - 70%

Answer 23

4 - 70%

Question 24

In a patient with bipolar disorder, what % of their lives is asymptomatic?

1 - 5%
2 - 20%
3 - 53%
4 - 93%

Answer 24

3 - 53%

Question 25

Why is a contralateral history important in bipolar disorder? 1 - more accurate than the patient 2 - patient may have no awareness of issue 3 - can often provide a diagnosis

Answer 25

2 - patient may have no awareness of issue

Question 26

What are the 2 phases of managing a bipolar patient? 1 - treat acute mood episode (depression or manic) 2 - maintenance outpatient appointments 3 - maintenance treatment for mood stability 4 - acute hospitalisation

Answer 26

1 - treat acute mood episode (depression or manic) 3 - maintenance treatment for mood stability

Question 27

Generally in a patient bipolar disorder who is having a manic episode, what class of medications should be stopped for fear of aggravating the episode? 1 - analgesis 2 - anti-depressants 3 - NSAIDs 4 - ACE-I

Answer 27

2 - anti-depressants - may need to slowly reduce rather than just stopping

Question 28

In a patient with an acute episode of mania, which drug class is the first line treatment? 1 - anti-depressants 2 - lithium 3 - atypical antipsychotic 4 - typical antipsychotic

Answer 28

3 - atypical antipsychotic - Olanzapine, Quetiapine or Risperidone are commonly tried 1st - core drugs are: Clozapine, Risperidone, Lurasidone, Olanzapine,Paliperidone, Quetiapine, Aripiprazole

Question 29

Why can benzodiazepines be useful in a patient who is experiencing an acute episode of mania? 1 - accentuates anti-psychotics 2 - reduces side effects of anti-psychotics 3 - promotes sleep and controls patients behaviour

Answer 29

3 - promotes sleep and controls patients behaviour

Question 30

The first line treatment for a patient with bipolar who is presenting with an acute episode of mania is an anti-psychotic drug. In addition, benzodiazepines be useful as adjunctive in treating the episode as it reduces brain activity through GABA, thus reducing neuronal activity and stimulation in the patient. However, once the patient is recovering, what is the maintenance treatment for bipolar disorder? 1 - diazepam 2 - zopiclone 3 - lithium 4 - aripiprazole

Answer 30

3 - lithium - can take a several days to be effective - diazepam = benzodiazepines - zopiclone = Nonbenzodiazepines - aripiprazole = atypical anti-psychotic

Question 31

How does lithium work? 1 - increases re-uptake of serotonin 2 - increases re-uptake of noradrenaline 3 - inhibits Ca2+ release at pre-synapse 4 - all of the above

Answer 31

3 - inhibits Ca2+ release at pre-synapse - specifically inhibits IP3 re-synthesis, which is was triggers the Ca2+ release

Question 32

What other mood stabiliser can be prescribed to a patient who is experiencing an acute manic episode? 1 - sodium valprolate 2 - flumazenil 3 - zopiclone 4 - aripiprazole

Answer 32

1 - sodium valprolate - blocks Na+ channels

Question 33

Electroconvulsive therapy (ECT) involves sending electrical currents through the brain, similar to a seizure. Which of the following must occur before ECT is used in a patient with an acute manic episode? 1 - drugs are ineffective 2 - seriously disturbed patient 3 - risk to themselves or others 4 - all of the above

Answer 33

4 - all of the above

Question 34

What is the risk of a relapse in a patient with bipolar disorder in any year? 1 - 0.1 - 0.2% 2 - 1-2% 3 - 10-20% 4 - >50%

Answer 34

3 - 10-20%

Question 35

In a patient with bipolar disorder, what is the average number of episodes they will have in a 25 year follow up period? 1 - 1 2 - 10 3 - 30 4 - >50

Answer 35

2 - 10 Average 10 episodes over 25-year follow up

Question 36

In a patient with bipolar disorder, do they have more manic or depressive episodes?

Answer 36

- depressive

Question 37

Which of the following is a form of non-pharmacological therapy that can be used in patients with bipolar disorder? 1 - CBT 2 - family therapy 3 - psychoeducation 4 - interpersonal therapy 5 - sleep hygiene 6 - all of the above

Answer 37

6 - all of the above - social service support is also very important

Question 38

When looking at preventing a relapse in a patient with bipolar disorder, what is the 1st line drug patients should be prescribed? 1 - anti-depressants 2 - lithium 3 - atypical antipsychotic 4 - typical antipsychotic

Answer 38

2 - lithium - reduces risk of relapse and suicide - can add sodium valprolate - lithium has a narrow therapeutic index so needs monitoring, renal especially)

Question 39

Why is mood monitoring important in patients with bipolar disorder? 1 - enhances communication with clinicians 2 - identifies early signs of relapse 3 - helps identify triggers of relapse 4 - all of the above

Answer 39

4 - all of the above - may also complete a depression and mania measure

Question 40

If a patient presents with an acute manic episode in later life, we need to investigate quickly. Why is this? 1 - acute mania is more dangerous in older patients 2 - can lead to increased suicide 3 - aetiology may be organic in nature 4 - all of the above

Answer 40

3 - aetiology may be organic in nature - basically it could be cause by illness or trauma