Bipolar affective disorder and case

For any emotional state to be considered not normal = intensity + duration + function impairment

Functional impact = self care, social, occupational, academic

Schizoaffective = can have features of both = schizophrenia can fit + mood disorders can fit

As episodic but can last a lifetime, it has to be lifelong

Can't educate manic patient until after mania settles at time of discharge

Early sign of relapse = sleep disturbances

Marrow

Casebook

2019

Youtube

Mania alone is BPAD but usually will have depression as well.

It;s a classic disease with inter episodic well functioming. unlike other disorders.

Lithium takes 3 weeks to act usually.valproate takes 5 days and typical antiphyscotics takes around 3 days to act. But thats not the reason why giving benzos...benzos is just supportive.

Diarhea can precipitate lithium toxicity?

Usualy depeoressin lasts for 6 to 8 months and mania fr 4 to 6 months.

dysthymia?

subsyndromal because never has been 2+3 for more than 2 weeks!!

Depression on dysthymia

avoid lithium if also have side effects

Add from ward classes done below

BIPOLAR AFFECTIVE DISORDER

can have persecutory and grandiose delusions where else persecutory delusions - depression with psychosis, szishophrenia, bipolar, dementia only describing one delusion is enough. must inquire into first rank symptoms to check for szhizhrophrnia

pecautions in mania - sexual disinbinhibition, reputation,

average age of onset is 18 years. but later can be due to injury like frontal lobe trauma

subtsnace abuse can lead to mania and mania can lead to substance abuse. so chronological order important for every episode

in DSM one manic episode qualifies as bipolar type 1 but in icd -10 we need at least one depressive episode.

"I would like to take collateral history to collobratae or contradict from these sources these specific points"

suicide can occur also in mania

always indirect sppech "he claims, he denies, he affirms, he understands..."

why number of poles important? to decide on a mood stabiliser.

slight mania is hypomania but slight depression is "subthreshold depressive symptoms" vs persistent depressive disorder two years more

cannabis can lead to schizophrenia or be associated with bipolar disorder

in mania - sexual history, driving history is important

MSE - dyed hair, tattoos, bright clothes, impulsivity, easily distractable, overly familiar, difficult to maintain social distance, social disinhibition, irritability

formal thought disorder is not a mania thing.

manic mood can be elated or irritable. mania can have second person hallucination

general note - insight has to be classified as good, partial or poor. state what exactly you asked.

immediate biological intervention is RT. antipsychotics (has mood stabilising effect but only in second generation) - olanzapine, haloperidol, risperidone. BZD like lorazepam (1-2mg) or clonazepam (1-2 weeks then tailor off). olanzapaine and respiridone can be used for prophylaxis for mania and even depression pfi pts get better on antipsych can continue that without starting mood stabiliser (lithium carbonate, sodium valproate, quitiapine, and lamotrigine). sodium valproate and lithius is good if manuc is more, but if depression then quietiapine and lamotrigine manic suicidal = lithium. two drugs that reduces suicidal tenencies is lithium and clozapine. only lithium and sodium vaplorate in SL. must decide on comorbidities. valproate shouldnt be used in liver probs, PCOS, and also pregnancy risk. Lithium takes time but valporate within 2-3 days. If pregnant cn take other drugs like olanzapine. for lithium narrow theraputic index so compliance is poor is containdication.

intersocial rhyythm therapy - two components interpersonal relationships and social rhythms

motivational enhancement therapy

functional levels should be accessed - less cognitive deficits in bipolar. cognitive deficits are mainly attention and concentration.

in bipolar intraepisodic functioning is normal, in schicho it is not + delusions are mood congruent vs non- congruent.

in bipolar depression cannot use antidepressants alone. why? coz can trigger mania. so must add mood stabiliser or low dose second generation antipsychotic.

check short oxford for duration of antidepressant therapy.