Bipolar Affective Disorder

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Bipolar Affective Disorder
2014-10-11 09:51:52
Bipolar MentalHealth Medicine Psychiatry

Epidemiology, aetiology, diagnostic criteria, management and prognosis for BPAD.
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  1. Epidemiology of BPAD?
    (lifetime risk, age of onset, sex ratio)
    • Lifetime risk = 1%
    • Average age of onset = 20
    • Sex ratio 1:1
  2. 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
  3. Biological symptoms of BPAD?
    • Decreased need for sleep - NOT associated w/ fatigue
    • Increase in energy levels. Can be seen as akathisia on MSE.
  4. 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
  5. 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.
  6. ICD-10 diagnostic criteria?
    • A) Current episode must fulfill criteria for mania or hypomania
    • PLUS...
    • B) Must have been at least one other affective disorder in the past
  7. 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
  8. Prognosis of BPAD?
    • 90% of patients have recurrent manic episodes
    • Completed suicide occurs in 10-15% of patients