BPAD Flashcards
What is ICD-10 of BPAF
2 + episodes of mood disturbances (depression, mania)
At least 1 episode has to have been mania/hypomania
what is DSM-5 of BPAD
Bipolar 1 – 1 episode of mania
(may be followed by episode of
depression/hypomania)
Bipolar 2 - at least one hypomanic episode and at least one major depressive episode
Mood in general
Normal to have changes in mood, sometimes in response to things.
When someone has a mood disorder its not the natural variation of mood, much more stark and prolonged changes.
What are the signs and symptoms of mania?
- Symptoms must be present for at least 7 days
- Marked disruption of functioning - RISKS
- Mood
- Elevated, irritable, or labile
- Disinhibition with their money- spending alot in short time e.g., gamble, huge debts quickly
- Engaging or insensitive
- Energy and goal directed activity
- Impulsive
- Poor judgement
- Disregard for risks
- Grandiosity
- Exaggerated
- Talents
- Sleep
- Decreased need cf insomnia
- Cognition
- Racing thoughts, Distractibility
- Flight of ideas, Poor memory- Flight of ideas is when peoples thought processes go so fast but they miss things out of speech so difficult to understand.
- Speech
- Loud, Rapid, Clanging- Clanging - when the links between thoughts become more about the sounds
- Jokes, Gestures
- Perceptions
- Delusions, hallucinations, first rank- First rank symptoms that are very typical of schizophrenia - third person voice, running commentary, interference with thoughts.
Mood is amazing. This must be present for more than 7 days, not just a short blip in their mood.
This impinges on all manners of your life - employment, relationships, safety
Large percentage of people also have psychosis with mania. Delusions often not in keeping with the mood - look and sound happy but talking about something scary or traumatic.
What are some psychotic symptoms of mania
- Usually in severe mania
- Grandiose delusions – related to identity or role
- Suspiciousness – can turn into persecutory delusions
- Pressured speech so severe unable to understand
- Irritable behaviour -> violent behaviour
- Preoccupation with thoughts/schemes lead to * severe self neglect
- Catatonic behaviour
- Complete loss of insight
What are the signs and symptoms of hypomania?
- Symptoms must be present for at least 4 days
- Similar to mania symptoms
- But milder
- No psychotic symptoms
- Functioning not markedly impaired
- If requires hospital admission = Mania
- If only hypomania: Bipolar Type II
- Is distinction between hypomania/mania arbitrary?
Milder than mania, no psychotic symptoms and function not as impaired.
What might be the differential diagnosis leading to bipolar disorder?
- Schizoaffective/Schizophrenia
- Substance misuse (stimulants)
- Organic disease (dementia, thyroid etc)
- Personality disorder (esp BPAD2 vs BPD)
Can be difficult to disentangle symptoms to see what it might be.
Bipolar patients tend to recover more fully between episodes.
What is the epidemiology of bipolar disorder?
- Lifetime prevalence 2.8% (≈Hyperthyroid)
- WHO 46th / 291 greatest cause of disability
- Greater than breast cancer and Alzheimer’s
- Male to Female 1:1
- Mean age of onset is 18-20 but presentation delayed for up to 10 years
- Substance misuse/anxiety disorders commonly comorbid
Can be difficult to diagnose someone quickly with bipolar as around the age where it’s common to move around different people etc might go unnoticed. Also often because people have a first depressive episode which they are treated for, and then don’t have their first manic episode for many years. Also wouldn’t really go to the doctor to complain about feeling really happy.
What is the course of action of bipolar disorder?
- Most people first present with depressive episode
- Manic episode usually within 5 years
- Manic episodes shorter (6 vs. 11 weeks)
- Rapid cycling (>4/yr)
- Gap between episodes shortens
- Pregnancy (>50% chance of relapse)
Generally as get older, episodes become more frequentPregnancy one of the biggest risk factors for the mental health of women generally. Can be very difficult to treat with concerns of wellbeing for the baby.
What is the prognosis of bipolar disorder?
- Chronic illness
- (40 year follow up – 16% remission)
- Hard to treat
- Mortality increased
- SMR = 1.6 (60% higher risk of death)
- Suicide rates much higher (SMR 15M and 22F)
Part of reason mortality increased due to lifestyle (smoking, risk taking) also partly due to the medications
What is the biological aetiology of bipolar disorder?
• Genetics • MZ: DZ 40:5 • 5 to 10% chance in first degree relatives • Overlap with Schizophrenia(!) • Neuroanatomy • Early development ○ White matter connections ○ Pruning prefrontal cortex ○ Leads to decreased connections between prefrontal networks and amygdala • Neurodegeneration ○ Control for confounders ○ Smaller total grey matter • Neurotransmitters
When thousands of genes across whole genome infer an increased risk for a condition.
What si the psycho-social aetiology of bipolar disorder?
- US study – link with childhood physical abuse
- New Zealand – involvement with child protection agency not linked
- Patients with BPAD
- Emotional and sexual abuse lower age of onset and increase risk of suicide
- No link with obstetric complications
- ACEs
What are the three phases of bipolar disorder to consider in treatment?
BPAD depression
Acute mania
Mood stabilisation
About bipolar depression
- Difficult
- Often unopposed antidepressant = MANIA
- Medication Naïve
- Fluoxetine + Olanzapine or Quetiapine (antipsychotic with mood stabilising properties)
- Consider Lamotrigine
- Already on mood stabiliser (lithium or valproate)
- Check level and increase dose as required
- Add Fluoxetine + Olanzapine
- Consider Lamotrigine + Lithium/Valproate
- Discontinue anti-depressant when depressive symptoms stop
Lamotrigine is an antiepileptic drug which can also be used as a mood stabiliser
Maintenance of health in bipolar disorder treatment
- Lithium – most effective long term pharmacological Rx
- Other mood stabilisers: Valproate, Lamotrigine, Carbamazepine
- Antipsychotics: Olanzapine, Quetiapine
Valporate has terrible implications for unborn children eg spina bifida
