Bipolar Affective Disorder
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Epidemiology of BPAD?
(lifetime risk, age of onset, sex ratio)
- Lifetime risk = 1%
- Average age of onset = 20
- Sex ratio 1:1
Aetiology of BPAD?
- 1st degree relatives of pt w/ BPAD have 7x risk of BPAD & 2x risk of unipolar depression
- Mutations in dopamine and 5-HT ion channels
- Childbirth; 50% risk of mania postpartum in those w/ untreated BPAD
Biological symptoms of BPAD?
- Decreased need for sleep - NOT associated w/ fatigue
- Increase in energy levels. Can be seen as akathisia on MSE.
Cognitive symptoms of BPAD?
- Increase in self-esteem or grandiosity.
- Poor concentration
- Accelerated thinking
- Difficult to interrupt due to pressure of speech.
- Flight of ideas
- Some hypomanic pts express themselves through letter writing, poetry, doodling or artwork.
- Impaired judgement due to lack of insight - makes treatment difficult
Psychotic symptoms of BPAD?
2/3 manic pts suffer from psychotic symptoms during an episode
- Disordered thought form:
- - circumstantiality/tangeniality (nb tangenial more indicative of psychotic symptoms)
- - flight of ideas
Perceptual disturbance; more subtle than in full-blown psychosis, eg colours more vivid, sounds louder etc.
ICD-10 diagnostic criteria?
- A) Current episode must fulfill criteria for mania or hypomania
- B) Must have been at least one other affective disorder in the past
Management of BPAD?
- Pharmacological treatment:
- - Mood stabilizers; lithium/valproate/carbamazipine)
- - Antipsychotics; stabilize mood & reduce psychotic symptoms (if BPAD w/ psychotic symptoms)
- - Withdraw antiDep during hypo/mania
- - NICE recommends antipsychotic (olanzapine, quetiapine, respiradone) to reduce behavioural disturbance
- If presenting w/ depression need to prescribe antiD w/ antimanic to avoid causing hypo/manic episode
- For maintenance, lithium, valproate or olanzapine. All mood stabilizers are teratogenic.
- ECT can be effective as an antimanic
Prognosis of BPAD?
- 90% of patients have recurrent manic episodes
- Completed suicide occurs in 10-15% of patients
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