Bipolar

Question 1

features of a hypomanic episode ICD 10?

Answer 1

1. some symptoms of mania but some control over actions and less severe
2. less functional impairment
3. OPD

Question 2

features of manic episode vs hypo in ICD 10?

Answer 2

1. impaired judgement and functioning
2. inpatient
3. can have mood congruent psychotic symptoms

Question 3

diagnostic criteria hypomania?

Answer 3

A. elated mood for 4 days 
\+
B. at least 3 of: 
1. increased activity/restless
2. talkative
3. poor concentration
4. not sleeping
5. increased libido
6. mild overspending/reckless
7. sociable/overfamiliar

Question 4

diagnostic criteria mania?

Answer 4

A. mood elevated for at least one week 
\+
B. at least 3 of: 
1. increased activity
2. increased talkativeness/pressure of speech
3. flight of ideas/ racing thoughts
4. disinhibition
5. less sleep
6. inflated self esteem/grandiosity
7. reckless behaviour, don't see consequences
8. distractible 
9 . increased libido

Question 5

psychosis in mania?

Answer 5

1. mood congruent
2. mood changes first then psychosis
3. ddx schizophrenia difficult

Question 6

bipolar disorder dx?

Answer 6

2+ episodes where mood and activity levels disturbed - at least one of them has to be mania/hypomania

Question 7

DSM vs ICD on bipolar

Answer 7

DSM divides into categories -

1. bipolar I - manic episode +/- depressive
2. bipolar II - depressive + hypomanic and no manic episode

Question 8

what are mixed affective episodes?

Answer 8

depressive and manic symptoms in same episode

Question 9

lifetime prevalence BAD?

Answer 9

approx 1%

Question 10

annual/point prevalence BAD?

Answer 10

1%

Question 11

age of onset

Answer 11

late teens/early 20s

earlier than unipolar

Question 12

chances of future manic episodes?

Answer 12

90% after 1

Question 13

rate of suicide?

Answer 13

attempted is 15-20%

completed is 10%

Question 14

px BAD

Answer 14

1. depressive episodes are longer than manic
2. more episodes than unipolar
3. 16% symptom free for 5 yrs

Question 15

presentation BAD

Answer 15

40% present with a depressive episode 1st

Question 16

psych ddx for BAD

Answer 16

1. schizophrenia/schizoaffective
2. organic brain lesion - frontal lobe
3. other psychotic disorder
4. personality disorder - EUPD/borderline
5. cyclothymia
6. substance misuse

Question 17

genetics of BAD

Answer 17

1. 1st degree rels 7x more likely to get
2. children have 50% chance
3. twins - MZ 60-70%, DZ 23%

Question 18

non genetic theories of BAD?

Answer 18

1. life events - possibly, not as much as unipolar
2. NTs - dopamine, NA, serotonin, glutamate all implicated
3. role for HPA axis - can have steroid induced mania

Question 19

initial treatment of manic episode?

Answer 19

1. antipsychotic (severe symptoms/behaviour)
OR 
2. valproate (not in women CBA)
OR
3. lithium (if future compliance likely)

Question 20

tx manic episode if response to initial is poor?

Answer 20

1. antipsychotic + valproate or lithium

2. consider adding short term benzo eg lorazepam or clonazepam

Question 21

if on lithium and mania?

Answer 21

check plasma levels and get levels 1-1.2mmol/L

+/- antipsychotic

Question 22

if on valproate and mania?

Answer 22

increase dose to get plasma levels to 125mg if can tolerate

+/- antipsychotic

Question 23

if on carbamazepine and mania?

Answer 23

add antipsychotic - may need higher dose

Question 24

if already antipsychotic and mania?

Answer 24

check compliance/dose increase if needed

+/- lithium/valproate