Podcast
Questions and Answers
According to Kraepelin, manic depressive psychosis is characterized by a long-term clinical course with a tendency to recurrence of mood disturbance.
According to Kraepelin, manic depressive psychosis is characterized by a long-term clinical course with a tendency to recurrence of mood disturbance.
True
Unipolar depression and bipolar disorder have distinct epidemiological differences with no overlap.
Unipolar depression and bipolar disorder have distinct epidemiological differences with no overlap.
False
The division into unipolar and bipolar cases is a useless classification.
The division into unipolar and bipolar cases is a useless classification.
False
Mania is characterized by a decrease in activity and self-important ideas.
Mania is characterized by a decrease in activity and self-important ideas.
Signup and view all the answers
Leonhard et al. pointed out that unipolar depression tends to show a distinct familial clustering.
Leonhard et al. pointed out that unipolar depression tends to show a distinct familial clustering.
Signup and view all the answers
Bipolar disorder is characterized by at least one episode of depression or hypomania.
Bipolar disorder is characterized by at least one episode of depression or hypomania.
Signup and view all the answers
Mood elevation in mania is characterized by a gloomy and pessimistic attitude.
Mood elevation in mania is characterized by a gloomy and pessimistic attitude.
Signup and view all the answers
The clinical features of mania include elevation of mood, decreased activity, and self-important ideas.
The clinical features of mania include elevation of mood, decreased activity, and self-important ideas.
Signup and view all the answers
Kraepelin's concept of manic depressive psychosis is still widely used today.
Kraepelin's concept of manic depressive psychosis is still widely used today.
Signup and view all the answers
Patients with mania often experience a regular 'diurnal' rhythm of mood variation during the day.
Patients with mania often experience a regular 'diurnal' rhythm of mood variation during the day.
Signup and view all the answers
Manic patients tend to be underactive and sluggish in their daily activities.
Manic patients tend to be underactive and sluggish in their daily activities.
Signup and view all the answers
In patients with mania, appetite is typically decreased, and food is eaten slowly and carefully.
In patients with mania, appetite is typically decreased, and food is eaten slowly and carefully.
Signup and view all the answers
The speech of manic patients is often slow and hesitant, with long pauses between sentences.
The speech of manic patients is often slow and hesitant, with long pauses between sentences.
Signup and view all the answers
Manic patients often have a flight of ideas that is difficult to follow, even when reviewed.
Manic patients often have a flight of ideas that is difficult to follow, even when reviewed.
Signup and view all the answers
Delusions of persecution and grandiose delusions are common features of schizophrenia, but not typically seen in mania.
Delusions of persecution and grandiose delusions are common features of schizophrenia, but not typically seen in mania.
Signup and view all the answers
Schneiderian first-rank symptoms are typically present in the majority of manic patients.
Schneiderian first-rank symptoms are typically present in the majority of manic patients.
Signup and view all the answers
Insight is usually preserved in manic patients, and they are aware of their need for treatment.
Insight is usually preserved in manic patients, and they are aware of their need for treatment.
Signup and view all the answers
Hallucinations are rare in mania and are typically inconsistent with the mood.
Hallucinations are rare in mania and are typically inconsistent with the mood.
Signup and view all the answers
Manic stupor is a condition characterized by rapid speech and rapid movements.
Manic stupor is a condition characterized by rapid speech and rapid movements.
Signup and view all the answers
Patients with manic stupor are usually accessible and answer questions readily.
Patients with manic stupor are usually accessible and answer questions readily.
Signup and view all the answers
The criteria for manic episode in ICD-10 and DSM-5 are vastly different.
The criteria for manic episode in ICD-10 and DSM-5 are vastly different.
Signup and view all the answers
Hypomania is a state of elevated mood that is more severe than mania.
Hypomania is a state of elevated mood that is more severe than mania.
Signup and view all the answers
Psychotic features are always present in hypomanic episodes.
Psychotic features are always present in hypomanic episodes.
Signup and view all the answers
Mixed mood states are characterized by alternating episodes of depression and mania that occur over a long period of time.
Mixed mood states are characterized by alternating episodes of depression and mania that occur over a long period of time.
Signup and view all the answers
Rapid cycling disorders are characterized by intervals of years between episodes.
Rapid cycling disorders are characterized by intervals of years between episodes.
Signup and view all the answers
Patients with manic stupor often neglect their personal hygiene and eating habits.
Patients with manic stupor often neglect their personal hygiene and eating habits.
Signup and view all the answers
The term 'folie circulaire' was coined by Wilhelm Griesinger to describe rapid cycling disorders.
The term 'folie circulaire' was coined by Wilhelm Griesinger to describe rapid cycling disorders.
Signup and view all the answers
The lifetime risk of rapid cycling in bipolar populations is probably in the range 30–40%.
The lifetime risk of rapid cycling in bipolar populations is probably in the range 30–40%.
Signup and view all the answers
Cyclothymia is a severe variant of bipolar disorder.
Cyclothymia is a severe variant of bipolar disorder.
Signup and view all the answers
All patients with bipolar disorder initially present with an episode of mania.
All patients with bipolar disorder initially present with an episode of mania.
Signup and view all the answers
Psychotic features are less common in patients with bipolar disorder than in those with unipolar depression.
Psychotic features are less common in patients with bipolar disorder than in those with unipolar depression.
Signup and view all the answers
The rates of bipolar disorder are higher in white populations than in minority groups within a country.
The rates of bipolar disorder are higher in white populations than in minority groups within a country.
Signup and view all the answers
In DSM-5, at least two episodes of mood disturbance are needed for the diagnosis of bipolar disorder.
In DSM-5, at least two episodes of mood disturbance are needed for the diagnosis of bipolar disorder.
Signup and view all the answers
Bipolar II disorder is characterized by the presence of at least one episode of mania and one episode of major depression.
Bipolar II disorder is characterized by the presence of at least one episode of mania and one episode of major depression.
Signup and view all the answers
Rapid cycling is a permanent phenomenon in bipolar disorder.
Rapid cycling is a permanent phenomenon in bipolar disorder.
Signup and view all the answers
Concomitant hyperthyroidism is common in rapid cycling disorder.
Concomitant hyperthyroidism is common in rapid cycling disorder.
Signup and view all the answers
Patients with definite depressive episodes may have features of bipolarity but meet the full DSM-5 criteria for mania or hypomania.
Patients with definite depressive episodes may have features of bipolarity but meet the full DSM-5 criteria for mania or hypomania.
Signup and view all the answers
The diagnosis of ‘bipolar and related disorder’ can be made for patients who meet the full DSM-5 criteria for mania or hypomania.
The diagnosis of ‘bipolar and related disorder’ can be made for patients who meet the full DSM-5 criteria for mania or hypomania.
Signup and view all the answers
The term bipolar spectrum is used exclusively in research settings.
The term bipolar spectrum is used exclusively in research settings.
Signup and view all the answers
The pharmacological treatment of bipolar depression is the same as that for patients with recurrent unipolar depression.
The pharmacological treatment of bipolar depression is the same as that for patients with recurrent unipolar depression.
Signup and view all the answers
Research has shown that depressed patients in the ‘bipolar spectrum’ do better when treated as having bipolar depression rather than unipolar depression.
Research has shown that depressed patients in the ‘bipolar spectrum’ do better when treated as having bipolar depression rather than unipolar depression.
Signup and view all the answers
The DSM-5 criteria for mania or hypomania require elevations of mood that last for at least 7 days.
The DSM-5 criteria for mania or hypomania require elevations of mood that last for at least 7 days.
Signup and view all the answers
The diagnosis of bipolar and related disorder requires specifying the reasons why the full criteria for mania or hypomania fail to be met.
The diagnosis of bipolar and related disorder requires specifying the reasons why the full criteria for mania or hypomania fail to be met.
Signup and view all the answers
The distinction between unipolar and bipolar depression has no implications for treatment.
The distinction between unipolar and bipolar depression has no implications for treatment.
Signup and view all the answers
Goodwin et al. (2016) found that depressed patients in the ‘bipolar spectrum’ do better when treated as having bipolar depression.
Goodwin et al. (2016) found that depressed patients in the ‘bipolar spectrum’ do better when treated as having bipolar depression.
Signup and view all the answers
Auditory hallucinations are never present in manic disorders.
Auditory hallucinations are never present in manic disorders.
Signup and view all the answers
A patient with a brain tumour can never be diagnosed with manic disorder.
A patient with a brain tumour can never be diagnosed with manic disorder.
Signup and view all the answers
Delusions of reference are characteristic of manic disorders but not of schizophrenia.
Delusions of reference are characteristic of manic disorders but not of schizophrenia.
Signup and view all the answers
In older patients, a diagnosis of manic disorder should be made without considering organic brain disease.
In older patients, a diagnosis of manic disorder should be made without considering organic brain disease.
Signup and view all the answers
The term schizoaffective is used when there is a clear distinction between manic and schizophrenic features.
The term schizoaffective is used when there is a clear distinction between manic and schizophrenic features.
Signup and view all the answers
A patient with a history of HIV infection can never be diagnosed with manic disorder.
A patient with a history of HIV infection can never be diagnosed with manic disorder.
Signup and view all the answers
In patients with manic disorder, extreme social disinhibition is always a sign of schizophrenia.
In patients with manic disorder, extreme social disinhibition is always a sign of schizophrenia.
Signup and view all the answers
A patient with no past history of affective disorder cannot be diagnosed with manic disorder.
A patient with no past history of affective disorder cannot be diagnosed with manic disorder.
Signup and view all the answers
The distinction between mania and excited behaviour caused by drug misuse can be made based on the patient's symptoms alone.
The distinction between mania and excited behaviour caused by drug misuse can be made based on the patient's symptoms alone.
Signup and view all the answers
Patients with bipolar II disorder often seek treatment for hypomanic episodes.
Patients with bipolar II disorder often seek treatment for hypomanic episodes.
Signup and view all the answers
In patients with manic disorder, a careful personal and family psychiatric history is never helpful in diagnosis.
In patients with manic disorder, a careful personal and family psychiatric history is never helpful in diagnosis.
Signup and view all the answers
The prevalence of bipolar disorder is higher in men than in women.
The prevalence of bipolar disorder is higher in men than in women.
Signup and view all the answers
First-degree relatives of patients with bipolar disorder have a decreased risk of recurrent unipolar depression.
First-degree relatives of patients with bipolar disorder have a decreased risk of recurrent unipolar depression.
Signup and view all the answers
The aetiology of bipolar disorder is mainly environmental.
The aetiology of bipolar disorder is mainly environmental.
Signup and view all the answers
Bipolar disorder is highly comorbid with anxiety disorders, but not with substance misuse.
Bipolar disorder is highly comorbid with anxiety disorders, but not with substance misuse.
Signup and view all the answers
Rapid cycling bipolar disorder is characterized by shifts in mood over years and months.
Rapid cycling bipolar disorder is characterized by shifts in mood over years and months.
Signup and view all the answers
The diagnosis of bipolar disorder can be made solely based on the presence of symptoms of mania or hypomania in the past history.
The diagnosis of bipolar disorder can be made solely based on the presence of symptoms of mania or hypomania in the past history.
Signup and view all the answers
The lifetime risk for bipolar disorder is in the range 10–20%.
The lifetime risk for bipolar disorder is in the range 10–20%.
Signup and view all the answers
The concordance rate for mood disorder in the monozygotic co-twin of a proband with bipolar disorder is around 40%.
The concordance rate for mood disorder in the monozygotic co-twin of a proband with bipolar disorder is around 40%.
Signup and view all the answers
The genetic liability to bipolar disorder results largely from the combined action of a single gene of large effect.
The genetic liability to bipolar disorder results largely from the combined action of a single gene of large effect.
Signup and view all the answers
Molecular linkage studies of mood disorders have been particularly revealing and have led to the identification of several genes with large effects.
Molecular linkage studies of mood disorders have been particularly revealing and have led to the identification of several genes with large effects.
Signup and view all the answers
About 5 replicated loci have been identified through genome-wide association studies (GWAS) in large numbers of bipolar patients.
About 5 replicated loci have been identified through genome-wide association studies (GWAS) in large numbers of bipolar patients.
Signup and view all the answers
The inherited risk of bipolar disorder is conferred by only a few genes of large effect.
The inherited risk of bipolar disorder is conferred by only a few genes of large effect.
Signup and view all the answers
A number of genes putatively involved in bipolar disorder impact on the activity of voltage-gated potassium channels.
A number of genes putatively involved in bipolar disorder impact on the activity of voltage-gated potassium channels.
Signup and view all the answers
Molecular genetic studies suggest a greater overlap in risk alleles between bipolar disorder and unipolar depression than for bipolar disorder and schizophrenia.
Molecular genetic studies suggest a greater overlap in risk alleles between bipolar disorder and unipolar depression than for bipolar disorder and schizophrenia.
Signup and view all the answers
The concordance rates for bipolar disorder in monozygotic twins suggest that genetic factors are the only contributing factors to the pathophysiology of bipolar illness.
The concordance rates for bipolar disorder in monozygotic twins suggest that genetic factors are the only contributing factors to the pathophysiology of bipolar illness.
Signup and view all the answers
Most of the environmental factors identified thus far seem specific for bipolar disorder and do not confer risk of psychiatric disorder more generally.
Most of the environmental factors identified thus far seem specific for bipolar disorder and do not confer risk of psychiatric disorder more generally.
Signup and view all the answers
Patients with bipolar disorder report similar rates of childhood sexual abuse as healthy controls.
Patients with bipolar disorder report similar rates of childhood sexual abuse as healthy controls.
Signup and view all the answers
Life events can trigger episodes of depression but not mania in bipolar patients.
Life events can trigger episodes of depression but not mania in bipolar patients.
Signup and view all the answers
Drugs that block dopamine receptors are commonly employed in the acute treatment of depression.
Drugs that block dopamine receptors are commonly employed in the acute treatment of depression.
Signup and view all the answers
Studies of dopamine metabolism and function have provided strong direct evidence for overactivity of dopamine pathways in patients with manic illness.
Studies of dopamine metabolism and function have provided strong direct evidence for overactivity of dopamine pathways in patients with manic illness.
Signup and view all the answers
Glutamate levels are typically decreased in bipolar patients.
Glutamate levels are typically decreased in bipolar patients.
Signup and view all the answers
Administration of exogenous corticosteroids in the treatment of general medical conditions can never give rise to an acute manic illness.
Administration of exogenous corticosteroids in the treatment of general medical conditions can never give rise to an acute manic illness.
Signup and view all the answers
Cortisol hypersecretion is typically reported in patients with unipolar depression but not in patients with bipolar disorder.
Cortisol hypersecretion is typically reported in patients with unipolar depression but not in patients with bipolar disorder.
Signup and view all the answers
Treatment with glucocorticoid antagonists has no beneficial effects on cognition in bipolar disorder.
Treatment with glucocorticoid antagonists has no beneficial effects on cognition in bipolar disorder.
Signup and view all the answers
Negative life events can only trigger episodes of depression, but not mania, in bipolar patients.
Negative life events can only trigger episodes of depression, but not mania, in bipolar patients.
Signup and view all the answers
Lithium treatment has been shown to prevent postpartum psychosis in mothers.
Lithium treatment has been shown to prevent postpartum psychosis in mothers.
Signup and view all the answers
Bipolar patients not taking lithium have been found to have higher hippocampal volumes compared to those with recurrent depression.
Bipolar patients not taking lithium have been found to have higher hippocampal volumes compared to those with recurrent depression.
Signup and view all the answers
Functional imaging studies have shown that bipolar patients have a reduced range of neural dysregulation compared to unipolar depression.
Functional imaging studies have shown that bipolar patients have a reduced range of neural dysregulation compared to unipolar depression.
Signup and view all the answers
Cognitive deficits in bipolar disorder are only present during acute illness episodes.
Cognitive deficits in bipolar disorder are only present during acute illness episodes.
Signup and view all the answers
The predisposition to develop bipolar disorder has a minor genetic contribution.
The predisposition to develop bipolar disorder has a minor genetic contribution.
Signup and view all the answers
Adverse early experiences, such as abuse, have no effect on the development of bipolar disorder.
Adverse early experiences, such as abuse, have no effect on the development of bipolar disorder.
Signup and view all the answers
Neuropathological changes in bipolar disorder are limited to the prefrontal cortex.
Neuropathological changes in bipolar disorder are limited to the prefrontal cortex.
Signup and view all the answers
Euthymic bipolar patients have been found to have normal neural responses to positive emotional stimuli.
Euthymic bipolar patients have been found to have normal neural responses to positive emotional stimuli.
Signup and view all the answers
The lifetime risk for bipolar disorder is in the range of 1–5%.
The lifetime risk for bipolar disorder is in the range of 1–5%.
Signup and view all the answers
Valproate has a later onset of activity compared to other mood stabilizers.
Valproate has a later onset of activity compared to other mood stabilizers.
Signup and view all the answers
Benzodiazepines are primarily used as a sole therapy in the treatment of mania.
Benzodiazepines are primarily used as a sole therapy in the treatment of mania.
Signup and view all the answers
Electroconvulsive therapy (ECT) has been shown to be ineffective in treating mixed affective states.
Electroconvulsive therapy (ECT) has been shown to be ineffective in treating mixed affective states.
Signup and view all the answers
The average length of a manic episode is approximately 3 months.
The average length of a manic episode is approximately 3 months.
Signup and view all the answers
Patients with bipolar disorder typically respond to pharmacological treatment for depression in the same way as patients with unipolar depression.
Patients with bipolar disorder typically respond to pharmacological treatment for depression in the same way as patients with unipolar depression.
Signup and view all the answers
Unilateral and bilateral ECT have been shown to have significantly different efficacy rates in treating mania.
Unilateral and bilateral ECT have been shown to have significantly different efficacy rates in treating mania.
Signup and view all the answers
Valproate has been shown to be less effective than lithium in treating patients with rapid cycling.
Valproate has been shown to be less effective than lithium in treating patients with rapid cycling.
Signup and view all the answers
Bipolar disorder typically begins as mania, with the first depressive episode manifesting about 5 years later.
Bipolar disorder typically begins as mania, with the first depressive episode manifesting about 5 years later.
Signup and view all the answers
Cardiovascular disease is a minor cause of increased mortality in bipolar patients.
Cardiovascular disease is a minor cause of increased mortality in bipolar patients.
Signup and view all the answers
The interval between episodes of major mood disturbance in bipolar patients becomes progressively longer with both age and the number of episodes.
The interval between episodes of major mood disturbance in bipolar patients becomes progressively longer with both age and the number of episodes.
Signup and view all the answers
Almost all patients with bipolar disorder experience mood-related symptomatology for more than half of the time.
Almost all patients with bipolar disorder experience mood-related symptomatology for more than half of the time.
Signup and view all the answers
Lithium is more effective than antipsychotic medication in the acute treatment of mania.
Lithium is more effective than antipsychotic medication in the acute treatment of mania.
Signup and view all the answers
More than 50% of bipolar patients achieve a period of 5 years of clinical stability with good social and occupational performance.
More than 50% of bipolar patients achieve a period of 5 years of clinical stability with good social and occupational performance.
Signup and view all the answers
Typical antipsychotic drugs have no limitations in the treatment of mania.
Typical antipsychotic drugs have no limitations in the treatment of mania.
Signup and view all the answers
The average length of a manic episode is about 1 year.
The average length of a manic episode is about 1 year.
Signup and view all the answers
Carbamazepine is not effective in the acute treatment of mania.
Carbamazepine is not effective in the acute treatment of mania.
Signup and view all the answers
Bipolar disorder usually begins at around 25 years of age.
Bipolar disorder usually begins at around 25 years of age.
Signup and view all the answers
About 15% of men and 10% of women hospitalized for bipolar illness died by suicide over a 40-year follow-up.
About 15% of men and 10% of women hospitalized for bipolar illness died by suicide over a 40-year follow-up.
Signup and view all the answers
The reduction in life expectancy in bipolar disorder is mainly due to suicide and accidents.
The reduction in life expectancy in bipolar disorder is mainly due to suicide and accidents.
Signup and view all the answers
Late-onset bipolar disorder is a common phenomenon.
Late-onset bipolar disorder is a common phenomenon.
Signup and view all the answers
Before the advent of modern drug treatment, the mortality of mania in the hospital setting was less than 10%.
Before the advent of modern drug treatment, the mortality of mania in the hospital setting was less than 10%.
Signup and view all the answers
The combination of lithium and valproate was associated with the highest relapse rate in the BALANCE study.
The combination of lithium and valproate was associated with the highest relapse rate in the BALANCE study.
Signup and view all the answers
Lamotrigine is licensed for the treatment of mood disorder in the UK.
Lamotrigine is licensed for the treatment of mood disorder in the UK.
Signup and view all the answers
Carbamazepine is more effective than lithium in 'classical' bipolar illness.
Carbamazepine is more effective than lithium in 'classical' bipolar illness.
Signup and view all the answers
Typical antipsychotic drugs are effective in protecting against depression in bipolar patients.
Typical antipsychotic drugs are effective in protecting against depression in bipolar patients.
Signup and view all the answers
The use of lithium in patients with recurrent mood disorders is associated with an increased risk of suicidal behavior.
The use of lithium in patients with recurrent mood disorders is associated with an increased risk of suicidal behavior.
Signup and view all the answers
Valproate is less effective than lithium in preventing manic relapse.
Valproate is less effective than lithium in preventing manic relapse.
Signup and view all the answers
Lamotrigine has a clearer prophylactic effect against mania than depression in patients with bipolar illness.
Lamotrigine has a clearer prophylactic effect against mania than depression in patients with bipolar illness.
Signup and view all the answers
There is evidence from randomized studies for the efficacy of olanzapine and quetiapine in the prevention of depression but not mania.
There is evidence from randomized studies for the efficacy of olanzapine and quetiapine in the prevention of depression but not mania.
Signup and view all the answers
Cognitive behaviour therapy has been found to be highly effective in preventing relapse in bipolar disorder.
Cognitive behaviour therapy has been found to be highly effective in preventing relapse in bipolar disorder.
Signup and view all the answers
Family-focused therapy has been found to be effective in reducing hospitalizations and symptomatology in bipolar patients.
Family-focused therapy has been found to be effective in reducing hospitalizations and symptomatology in bipolar patients.
Signup and view all the answers
Interpersonal and social rhythm therapy is based on interpersonal therapy and focuses on helping patients to maintain regular sleep-activity schedules.
Interpersonal and social rhythm therapy is based on interpersonal therapy and focuses on helping patients to maintain regular sleep-activity schedules.
Signup and view all the answers
Group psychoeducation has been shown to reduce relapse rates by over 50% in a 5-year follow-up period.
Group psychoeducation has been shown to reduce relapse rates by over 50% in a 5-year follow-up period.
Signup and view all the answers
Psychotherapy has been extensively studied in bipolar patients and has been found to be highly effective in preventing relapse.
Psychotherapy has been extensively studied in bipolar patients and has been found to be highly effective in preventing relapse.
Signup and view all the answers
The design of randomized studies in bipolar disorder typically involves continuing antipsychotic treatment in patients who have not responded to short-term, open-label treatment.
The design of randomized studies in bipolar disorder typically involves continuing antipsychotic treatment in patients who have not responded to short-term, open-label treatment.
Signup and view all the answers
Cognitive behavioural techniques may be valuable in helping patients to accept their illness and the need for medical treatment.
Cognitive behavioural techniques may be valuable in helping patients to accept their illness and the need for medical treatment.
Signup and view all the answers
Family-based therapy aims to improve relationships and support for the patient within the family by utilizing psychoeducation and training in communication skills.
Family-based therapy aims to improve relationships and support for the patient within the family by utilizing psychoeducation and training in communication skills.
Signup and view all the answers
Structured psychotherapies in bipolar disorder have usually been directed to patients during acute episodes of mood disturbance.
Structured psychotherapies in bipolar disorder have usually been directed to patients during acute episodes of mood disturbance.
Signup and view all the answers
Antidepressant treatment has been shown to be highly effective in bipolar depression, with a low risk of inducing mania.
Antidepressant treatment has been shown to be highly effective in bipolar depression, with a low risk of inducing mania.
Signup and view all the answers
Tricyclic antidepressants are thought to have a low risk of inducing mania in bipolar depressed patients.
Tricyclic antidepressants are thought to have a low risk of inducing mania in bipolar depressed patients.
Signup and view all the answers
Lithium has been shown to be highly effective in the acute treatment of bipolar depression.
Lithium has been shown to be highly effective in the acute treatment of bipolar depression.
Signup and view all the answers
Quetiapine has been shown to be highly effective in the treatment of bipolar depression, both as a monotherapy and in combination with fluoxetine.
Quetiapine has been shown to be highly effective in the treatment of bipolar depression, both as a monotherapy and in combination with fluoxetine.
Signup and view all the answers
Lamotrigine has been shown to be ineffective in the treatment of bipolar depression.
Lamotrigine has been shown to be ineffective in the treatment of bipolar depression.
Signup and view all the answers
Electroconvulsive therapy (ECT) is not effective in the treatment of resistant depression in bipolar patients.
Electroconvulsive therapy (ECT) is not effective in the treatment of resistant depression in bipolar patients.
Signup and view all the answers
Folic acid has been shown to enhance the therapeutic effect of lamotrigine in the treatment of bipolar depression.
Folic acid has been shown to enhance the therapeutic effect of lamotrigine in the treatment of bipolar depression.
Signup and view all the answers
Diagnosis of mania depends on a detailed physical examination of the patient.
Diagnosis of mania depends on a detailed physical examination of the patient.
Signup and view all the answers
Mildly disinhibited behavior can result from frontal lobe lesions and not from mania.
Mildly disinhibited behavior can result from frontal lobe lesions and not from mania.
Signup and view all the answers
A urine screen for illegal substances is not necessary in the assessment of mania.
A urine screen for illegal substances is not necessary in the assessment of mania.
Signup and view all the answers
Manic patients are always able to recognize the extent of their abnormal behavior.
Manic patients are always able to recognize the extent of their abnormal behavior.
Signup and view all the answers
The severity of mania can be judged solely on the basis of the patient's self-report.
The severity of mania can be judged solely on the basis of the patient's self-report.
Signup and view all the answers
Life events never provoke the onset of manic illness.
Life events never provoke the onset of manic illness.
Signup and view all the answers
Manic episodes can follow treatment with drugs, especially steroids or antidepressants.
Manic episodes can follow treatment with drugs, especially steroids or antidepressants.
Signup and view all the answers
A doctor's assessment of a patient with mania is always accurate and can never be misleading.
A doctor's assessment of a patient with mania is always accurate and can never be misleading.
Signup and view all the answers
The assessment of mania involves only deciding on the diagnosis and assessing the severity of the disorder.
The assessment of mania involves only deciding on the diagnosis and assessing the severity of the disorder.
Signup and view all the answers
Differential diagnosis is not important in the assessment of mania.
Differential diagnosis is not important in the assessment of mania.
Signup and view all the answers
Concomitant treatment with antipsychotic drugs is not needed when treating manic episodes
Concomitant treatment with antipsychotic drugs is not needed when treating manic episodes
Signup and view all the answers
ECT is a commonly used treatment for mania and has a strong evidence base for its effectiveness
ECT is a commonly used treatment for mania and has a strong evidence base for its effectiveness
Signup and view all the answers
A sustained change to a depressive syndrome often requires no additional treatment
A sustained change to a depressive syndrome often requires no additional treatment
Signup and view all the answers
Lithium should be withdrawn quickly to prevent rebound mania
Lithium should be withdrawn quickly to prevent rebound mania
Signup and view all the answers
Antidepressant drugs are a first-line choice for the treatment of bipolar depression
Antidepressant drugs are a first-line choice for the treatment of bipolar depression
Signup and view all the answers
Lamotrigine is ineffective in the treatment of bipolar depression and can induce mania
Lamotrigine is ineffective in the treatment of bipolar depression and can induce mania
Signup and view all the answers
Bipolar depression is a rare phenomenon in bipolar illness
Bipolar depression is a rare phenomenon in bipolar illness
Signup and view all the answers
ECT may be helpful for mixed affective states in which depressive symptoms are not prominent
ECT may be helpful for mixed affective states in which depressive symptoms are not prominent
Signup and view all the answers
A careful watch should not be kept for symptoms of depressive disorder during treatment
A careful watch should not be kept for symptoms of depressive disorder during treatment
Signup and view all the answers
Continuation treatment for mania is not necessary, and treatment can be withdrawn immediately after the patient has been asymptomatic
Continuation treatment for mania is not necessary, and treatment can be withdrawn immediately after the patient has been asymptomatic
Signup and view all the answers
In all but the most severe cases, hospital admission is not advisable for patients with mania.
In all but the most severe cases, hospital admission is not advisable for patients with mania.
Signup and view all the answers
Supportive, reality-orientated psychotherapy is not an important element of treatment for manic patients.
Supportive, reality-orientated psychotherapy is not an important element of treatment for manic patients.
Signup and view all the answers
Mood stabilizers are generally used as primary agents in the management of acute mania in the UK.
Mood stabilizers are generally used as primary agents in the management of acute mania in the UK.
Signup and view all the answers
Lithium is typically used for mania with prominent dysphoric or mixed states.
Lithium is typically used for mania with prominent dysphoric or mixed states.
Signup and view all the answers
Benzodiazepines are not used as an adjunct to reduce overactivity and permit sleep in manic patients.
Benzodiazepines are not used as an adjunct to reduce overactivity and permit sleep in manic patients.
Signup and view all the answers
If a patient presents with a manic episode and is already taking a mood stabilizer, the first step is to switch to a different mood stabilizer.
If a patient presents with a manic episode and is already taking a mood stabilizer, the first step is to switch to a different mood stabilizer.
Signup and view all the answers
The therapeutic alliance with the manic patient is not an important goal of treatment.
The therapeutic alliance with the manic patient is not an important goal of treatment.
Signup and view all the answers
Nursing staff do not play a key role in the management of manic patients in hospital.
Nursing staff do not play a key role in the management of manic patients in hospital.
Signup and view all the answers
Educational sessions are not important when the patient is more settled.
Educational sessions are not important when the patient is more settled.
Signup and view all the answers
The patient's responsibilities with regard to the care of dependent children or at work are not considered in the management of mania.
The patient's responsibilities with regard to the care of dependent children or at work are not considered in the management of mania.
Signup and view all the answers
Valproate is a safe option for women of childbearing age without any concerns.
Valproate is a safe option for women of childbearing age without any concerns.
Signup and view all the answers
Lamotrigine dosing does not need to be cautious when initiated in a patient taking valproate.
Lamotrigine dosing does not need to be cautious when initiated in a patient taking valproate.
Signup and view all the answers
ECT is not effective in treating severe depressive symptoms in patients with bipolar disorder.
ECT is not effective in treating severe depressive symptoms in patients with bipolar disorder.
Signup and view all the answers
Structured psychotherapies have been widely studied in acute bipolar depression.
Structured psychotherapies have been widely studied in acute bipolar depression.
Signup and view all the answers
Long-term maintenance treatment with a mood stabilizer or an atypical antipsychotic is not necessary for patients who have had two or more episodes of illness in less than 5 years.
Long-term maintenance treatment with a mood stabilizer or an atypical antipsychotic is not necessary for patients who have had two or more episodes of illness in less than 5 years.
Signup and view all the answers
Conventional antidepressants are never justified in short-term treatment of bipolar disorder.
Conventional antidepressants are never justified in short-term treatment of bipolar disorder.
Signup and view all the answers
The same cautions around antidepressant use should always apply to depressed patients with bipolar II disorder.
The same cautions around antidepressant use should always apply to depressed patients with bipolar II disorder.
Signup and view all the answers
Antidepressant treatment should be continued indefinitely in patients with bipolar disorder who respond to treatment.
Antidepressant treatment should be continued indefinitely in patients with bipolar disorder who respond to treatment.
Signup and view all the answers
Quetiapine is not an effective long-term maintenance treatment option for patients with bipolar disorder.
Quetiapine is not an effective long-term maintenance treatment option for patients with bipolar disorder.
Signup and view all the answers
Cognitive behaviour therapy has not been shown to be effective in unipolar depression.
Cognitive behaviour therapy has not been shown to be effective in unipolar depression.
Signup and view all the answers
The use of lithium to prevent further episodes of bipolar disorder is not associated with a decreased risk of suicidal behavior.
The use of lithium to prevent further episodes of bipolar disorder is not associated with a decreased risk of suicidal behavior.
Signup and view all the answers
Patients with bipolar disorder typically respond to pharmacological treatment for depression in a different way than patients with unipolar depression.
Patients with bipolar disorder typically respond to pharmacological treatment for depression in a different way than patients with unipolar depression.
Signup and view all the answers
Valproate should be prescribed as a first choice to women of childbearing age.
Valproate should be prescribed as a first choice to women of childbearing age.
Signup and view all the answers
The risk of relapse is not increased when patients stop lithium suddenly.
The risk of relapse is not increased when patients stop lithium suddenly.
Signup and view all the answers
People with bipolar disorder are always willing to consider long-term treatment with medication.
People with bipolar disorder are always willing to consider long-term treatment with medication.
Signup and view all the answers
Quetiapine is not effective in preventing both depression and mania in patients with bipolar disorder.
Quetiapine is not effective in preventing both depression and mania in patients with bipolar disorder.
Signup and view all the answers
Lamotrigine is more effective in preventing mania than depression in patients with bipolar illness.
Lamotrigine is more effective in preventing mania than depression in patients with bipolar illness.
Signup and view all the answers
In the UK, valproate is regarded as the first choice of mood stabilizer.
In the UK, valproate is regarded as the first choice of mood stabilizer.
Signup and view all the answers
Mood stabilizing drugs can completely eliminate feelings of joy and creativity.
Mood stabilizing drugs can completely eliminate feelings of joy and creativity.
Signup and view all the answers
Regular clinical and biochemical monitoring of the physical health of bipolar patients is not important.
Regular clinical and biochemical monitoring of the physical health of bipolar patients is not important.
Signup and view all the answers
Psychological treatment approaches for bipolar disorder do not employ education about the illness and enhancing self-management.
Psychological treatment approaches for bipolar disorder do not employ education about the illness and enhancing self-management.
Signup and view all the answers
The use of medication for mood stabilization is a sign of personal weakness.
The use of medication for mood stabilization is a sign of personal weakness.
Signup and view all the answers
Jamison's personal account provides an excellent explanation of the reasons for reluctance to consider long-term treatment with medication.
Jamison's personal account provides an excellent explanation of the reasons for reluctance to consider long-term treatment with medication.
Signup and view all the answers
The effectiveness of treatment in clinical practice is not often disappointing for bipolar patients.
The effectiveness of treatment in clinical practice is not often disappointing for bipolar patients.
Signup and view all the answers
The use of psychosocial measures outlined in the text does not enhance the overall effectiveness of treatment plans for bipolar disorder.
The use of psychosocial measures outlined in the text does not enhance the overall effectiveness of treatment plans for bipolar disorder.
Signup and view all the answers
Lithium is not effective in treating severe depressive symptoms in patients with bipolar disorder.
Lithium is not effective in treating severe depressive symptoms in patients with bipolar disorder.
Signup and view all the answers
Stigma is not an important issue in the reluctance to consider long-term treatment with medication.
Stigma is not an important issue in the reluctance to consider long-term treatment with medication.
Signup and view all the answers
Randomized trials of certain approaches, such as psychoeducational programmes and family intervention, are not promising in enhancing the effectiveness of treatment plans for bipolar disorder.
Randomized trials of certain approaches, such as psychoeducational programmes and family intervention, are not promising in enhancing the effectiveness of treatment plans for bipolar disorder.
Signup and view all the answers
Valproate is the most popular choice of mood stabilizer in both the UK and the USA.
Valproate is the most popular choice of mood stabilizer in both the UK and the USA.
Signup and view all the answers
Patients with bipolar disorder never have difficulties in accepting a diagnosis of a lifelong condition.
Patients with bipolar disorder never have difficulties in accepting a diagnosis of a lifelong condition.
Signup and view all the answers
The lifetime risk of bipolar disorder is around 15%.
The lifetime risk of bipolar disorder is around 15%.
Signup and view all the answers
The average age of onset for patients with bipolar disorder is around 27 years.
The average age of onset for patients with bipolar disorder is around 27 years.
Signup and view all the answers
The lifetime risk of unipolar disorder for first-degree relatives of patients with bipolar disorder is around 20–30%.
The lifetime risk of unipolar disorder for first-degree relatives of patients with bipolar disorder is around 20–30%.
Signup and view all the answers
The average number of episodes for patients with bipolar disorder is around 4.
The average number of episodes for patients with bipolar disorder is around 4.
Signup and view all the answers
The sex ratio for unipolar disorder is around 1:1.
The sex ratio for unipolar disorder is around 1:1.
Signup and view all the answers
Mood elevation in a manic episode is always accompanied by increased energy and a decreased need for sleep.
Mood elevation in a manic episode is always accompanied by increased energy and a decreased need for sleep.
Signup and view all the answers
For diagnosis, the manic episode should last for at least two weeks and should be severe enough to disrupt ordinary work and social activities.
For diagnosis, the manic episode should last for at least two weeks and should be severe enough to disrupt ordinary work and social activities.
Signup and view all the answers
In a manic episode, perceptual disorders may occur, such as an appreciation of colours being dull and uninteresting.
In a manic episode, perceptual disorders may occur, such as an appreciation of colours being dull and uninteresting.
Signup and view all the answers
In a manic episode, self-esteem is often deflated and pessimistic ideas are freely expressed.
In a manic episode, self-esteem is often deflated and pessimistic ideas are freely expressed.
Signup and view all the answers
In a manic episode, the individual may become less talkative and less sociable.
In a manic episode, the individual may become less talkative and less sociable.
Signup and view all the answers
In a manic episode, the individual's attention can be sustained for long periods of time.
In a manic episode, the individual's attention can be sustained for long periods of time.
Signup and view all the answers
What should be considered when a person develops mania or hypomania and is taking an antidepressant?
What should be considered when a person develops mania or hypomania and is taking an antidepressant?
Signup and view all the answers
What is the initial treatment option for a person who develops mania or hypomania and is not taking an antipsychotic or mood stabilizer?
What is the initial treatment option for a person who develops mania or hypomania and is not taking an antipsychotic or mood stabilizer?
Signup and view all the answers
What should be considered if an alternative antipsychotic is not sufficiently effective at the maximum licensed dose?
What should be considered if an alternative antipsychotic is not sufficiently effective at the maximum licensed dose?
Signup and view all the answers
What is the next step if adding lithium is ineffective or not suitable?
What is the next step if adding lithium is ineffective or not suitable?
Signup and view all the answers
What should be considered if a person is already taking a mood stabilizer such as lithium or valproate?
What should be considered if a person is already taking a mood stabilizer such as lithium or valproate?
Signup and view all the answers
What factors should be taken into account when offering an antipsychotic?
What factors should be taken into account when offering an antipsychotic?
Signup and view all the answers
If a person develops moderate or severe bipolar depression and is taking either lithium or valproate, increasing the mood stabiliser to within the maximum permitted by the therapeutic range should not be considered.
If a person develops moderate or severe bipolar depression and is taking either lithium or valproate, increasing the mood stabiliser to within the maximum permitted by the therapeutic range should not be considered.
Signup and view all the answers
Lamotrigine should be considered as an initial treatment option for a person who develops moderate or severe bipolar depression and is not taking a drug to treat their bipolar disorder.
Lamotrigine should be considered as an initial treatment option for a person who develops moderate or severe bipolar depression and is not taking a drug to treat their bipolar disorder.
Signup and view all the answers
When adding lamotrigine to valproate, the British National Formulary does not need to be followed.
When adding lamotrigine to valproate, the British National Formulary does not need to be followed.
Signup and view all the answers
Quetiapine is not an effective treatment option for moderate or severe bipolar depression.
Quetiapine is not an effective treatment option for moderate or severe bipolar depression.
Signup and view all the answers
If a person develops moderate or severe bipolar depression and is not taking a drug to treat their bipolar disorder, olanzapine on its own should be the initial treatment option.
If a person develops moderate or severe bipolar depression and is not taking a drug to treat their bipolar disorder, olanzapine on its own should be the initial treatment option.
Signup and view all the answers
What is the minimum frequency at which physical health checks should be performed for people with bipolar disorder?
What is the minimum frequency at which physical health checks should be performed for people with bipolar disorder?
Signup and view all the answers
Which of the following is NOT included in the physical health check for people with bipolar disorder?
Which of the following is NOT included in the physical health check for people with bipolar disorder?
Signup and view all the answers
What is the purpose of monitoring liver function during physical health checks for people with bipolar disorder?
What is the purpose of monitoring liver function during physical health checks for people with bipolar disorder?
Signup and view all the answers
Which of the following health metrics is NOT included in the metabolic status assessment during physical health checks for people with bipolar disorder?
Which of the following health metrics is NOT included in the metabolic status assessment during physical health checks for people with bipolar disorder?
Signup and view all the answers
Why is it important to monitor renal function during physical health checks for people with bipolar disorder?
Why is it important to monitor renal function during physical health checks for people with bipolar disorder?
Signup and view all the answers
In psychological approaches to bipolar disorder, patients are advised to avoid sleep patterns and regular social routines.
In psychological approaches to bipolar disorder, patients are advised to avoid sleep patterns and regular social routines.
Signup and view all the answers
Identification of early subjective signs of relapse is not an important aspect of psychological approaches to bipolar disorder.
Identification of early subjective signs of relapse is not an important aspect of psychological approaches to bipolar disorder.
Signup and view all the answers
Medication is not discussed in psychological approaches to bipolar disorder, as it is not relevant to the patient's treatment plan.
Medication is not discussed in psychological approaches to bipolar disorder, as it is not relevant to the patient's treatment plan.
Signup and view all the answers
Patients are not advised to avoid triggers for relapse, such as substance misuse, in psychological approaches to bipolar disorder.
Patients are not advised to avoid triggers for relapse, such as substance misuse, in psychological approaches to bipolar disorder.
Signup and view all the answers
Education about the importance of medication is not provided to patients with bipolar disorder as part of their treatment plan.
Education about the importance of medication is not provided to patients with bipolar disorder as part of their treatment plan.
Signup and view all the answers
Study Notes
Assessment of Mania
- Decide on the diagnosis of mania, assessing the severity of the disorder and its causes.
- Assess the patient's social resources and the impact of the illness on others.
- Diagnosis involves a careful history and examination, including taking a history from relatives.
- Consider alternative diagnoses, such as frontal lobe lesions, and perform a urine screen for illegal substances.
Severity of Mania
- Assess severity by interviewing an informant and the patient, as manic patients may exert self-control during an interview.
- Identify any life events that may have provoked the onset of mania, such as physical illness or drug treatment.
Treatment of Mania
- Use antipsychotic drugs, such as haloperidol, olanzapine, quetiapine, or risperidone, as the first line of treatment.
- Consider adding a mood stabilizer, such as lithium or valproate, if the response to antipsychotic drugs is unsatisfactory.
- May use ECT (electroconvulsive therapy) for severe or treatment-resistant cases.
Continuation Treatment
- Continue treatment for at least 6 months to prevent relapse.
- Gradually withdraw treatment, particularly lithium, to prevent "rebound" mania.
Bipolar Depression
- Depressive episodes are common in bipolar disorder and are associated with the majority of the illness burden.
- Assess depression using the methods described in Chapter 9, with particular attention to suicidal thinking.
- Antidepressant drugs are not a first-line choice for bipolar depression, but may be used in combination with mood stabilizers.
Management of Mania
- Hospital admission is often necessary to protect the patient from the consequences of their behavior.
- Develop a therapeutic alliance with the patient, using an understanding and firm approach.
- Use supportive, reality-orientated psychotherapy and educational sessions to help the patient and their family.
Medication
- Antipsychotic drugs, such as olanzapine, quetiapine, and risperidone, are commonly used to treat mania.
- Mood stabilizers, such as lithium and valproate, are used for longer-term prophylaxis or where the initial response to antipsychotic drugs is unsatisfactory.
Prevention of Relapse and Recurrence
- Use maintenance treatment with a mood stabilizer or atypical antipsychotic drug to prevent relapse and recurrence.
- Monitor the patient's plasma lithium levels and renal and thyroid function regularly.
- Educate the patient about the importance of medication and the risks of stopping treatment suddenly.
Psychosocial Approaches
- Use psychological treatment approaches, such as education about the illness and enhancing self-management, to help patients with bipolar disorder.
- Focus on adjustment to the diagnosis, interpersonal and relationship difficulties, occupational problems, and substance misuse.
Epidemiology of Bipolar and Unipolar Disorder
- The lifetime risk of bipolar disorder is about 1%, and the sex ratio is 1:1.
- The average age of onset is 18 years, and 90% of patients have recurrence.
- First-degree relatives have a lifetime risk of bipolar disorder of about 10% and unipolar disorder of 20-30%.### Bipolar Disorders
- Bipolar disorder is a group of conditions characterized by depressive episodes and at least one episode of mania or hypomania.
- The course of bipolar disorder is marked by a tendency to recurrence of mood disturbance.
- Bipolar disorder tends to show a distinct familial clustering.
Clinical Features of Mania
- The central features of mania include:
- Elevation of mood
- Increased activity
- Self-important ideas
- Mood:
- Can be cheerful and optimistic, or irritable
- May vary during the day, but not with a regular diurnal rhythm
- Appearance and behavior:
- Patients may be overactive and have a disheveled appearance
- May have an increased appetite and reduced sleep
- May engage in reckless behavior, such as extravagant spending or sexual indiscretions
- Speech and thought:
- Rapid and copious speech
- Flight of ideas, with rapid changes in thought
- Expansive ideas, with grandiose delusions or delusions of persecution
- Perceptual disturbances:
- Hallucinations, usually consistent with the mood
- Insight is often impaired, and patients may not think of themselves as ill or in need of treatment.
Hypomanic Episode
- A state of elevated mood that is less severe than mania
- Criteria for hypomanic episode:
- Persistent mild elevation of mood for at least 4 days
- Increased energy and activity
- Feelings of wellbeing
- Increased talkativeness and overfamiliarity
- Decreased need for sleep
Mixed Mood (Affective) States
- Depressive and manic symptoms can occur simultaneously
- Patients may be overactive and overtalkative, but still have profoundly depressive thoughts
Rapid Cycling Disorder
- A type of bipolar disorder characterized by:
- Frequent recurrence of mood disturbance (at least 4 episodes per year)
- Episodes are separated by a period of remission or a switch to an episode of opposite polarity
- More common in women, and often triggered by antidepressant drug treatment
Cyclothymia
- A milder variant of bipolar disorder, characterized by:
- Persistent instability of mood
- Numerous periods of mild elation or depression
- Episodes do not meet severity criteria for mania or major depression
Depression in Bipolar Disorder
- Depressive episodes are common in bipolar disorder
- Ability to predict which patients will develop bipolar illness is limited
- Family history of bipolar disorder can provide a useful clue
- Presence of hypomanic or mixed symptoms at initial presentation may have some predictive value
Distinguishing Bipolar Disorder from Unipolar Depression
- Can be challenging, as there is a high degree of overlap between the two conditions
- Presence of hypomanic symptoms, early age of onset, and clinical severity may be indicative of bipolar disorder
- Psychomotor retardation, early morning awakening, morning worsening, and psychotic features are more common in bipolar depression### Genetic Causes of Bipolar Disorder
- Family and twin studies have shown a high heritability of bipolar disorder, estimated to be around 85% (Bienvenu et al., 2011)
- The concordance rate for mood disorder in monozygotic co-twins of a proband with bipolar disorder is around 60%, indicating a strong genetic component
- The genetic liability to bipolar disorder likely results from the combined action of multiple genes of modest or small effect (polygenic inheritance)
- Rare structural chromosomal abnormalities (copy number variants) and gene-gene interactions (epistasis) may also contribute to the genetic risk
Molecular Genetics of Bipolar Disorder
- Genome-wide association studies (GWAS) have identified several risk loci, including CACNA1C, which encodes a subunit of the L-type calcium channel
- About 10 replicated loci have been identified so far, with some genes clustering around biologically meaningful processes (e.g. voltage-gated calcium channels)
- Many of the genes identified in GWAS studies of bipolar disorder also appear to be risk alleles for the development of schizophrenia
Environmental Factors in Bipolar Disorder
- Childhood sexual abuse is a known risk factor for the development of psychiatric disorder, including bipolar disorder
- Life events, such as negative events or goal attainment, can trigger episodes of both depression and mania in bipolar patients
- Social support and expressed emotion can also influence the course of bipolar disorder
Neurobiological Approaches to Bipolar Disorder
- Dopamine has been implicated in the pathophysiology of bipolar disorder, with some studies suggesting a heightened responsivity to changes in dopamine neurotransmission in patients at risk of mania
- Glutamate levels may be increased in bipolar patients, which could be a potential biomarker for diagnosis
- Cortisol hypersecretion has been reported in patients with bipolar disorder, which may be linked to cognitive impairment
- Oestrogen and progesterone levels may also play a role in the development of bipolar disorder, particularly in the postpartum period
Neuroimaging and Neuropathological Changes in Bipolar Disorder
- Studies using MRI and diffusion tensor imaging (DTI) have revealed abnormalities in certain white matter tracts, including reduced hippocampal volumes
- Functional imaging studies have shown abnormalities in neural responses to emotional stimuli, including increased activity in the amygdala and reduced activity in prefrontal cortical regions
- Neuropathological changes, including reductions in neuronal and glial cell density, have been reported in patients with bipolar disorder
Cognitive Deficits in Bipolar Disorder
- Cognitive deficits are present in bipolar disorder during both acute illness and periods of euthymia
- Deficits are apparent in first-episode patients and cover a range of neuropsychological domains, including executive function, verbal memory, attention, and processing speed
Treatment of Bipolar Disorder
- Valproate has been shown to possess antimanic activity, with a rapid onset of action
- Benzodiazepines can be useful adjuncts in the treatment of mania, particularly for rapid calming and restoration of sleep
- Electroconvulsive therapy (ECT) has been shown to be effective in acute mania, with a response rate of around 80%
- Continuation treatment with medication is important to prevent relapse, with a typical duration of at least 6 months
Clinical Features of Manic Episode
- Mood is elevated out of keeping with the individual's circumstances, with varying degrees of excitement and irritability
- Increased energy results in overactivity, pressure of speech, and decreased need for sleep
- Social inhibitions are lost, attention cannot be sustained, and there is often marked distractibility
- Self-esteem is inflated, and grandiose and overoptimistic ideas are freely expressed
Classification of Bipolar Disorder
- ICD-10 and DSM-5 criteria for bipolar disorder, including manic episode, hypomanic episode, and depression
- Bipolar I and bipolar II disorders, with differing levels of severity and psychotic symptoms
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your understanding of bipolar disorders, a group of conditions characterized by depressive episodes and at least one episode of mania or hypomania. Learn about the history of the concept, including Kraepelin's manic depressive psychosis and Leonhard's contributions. Evaluate your knowledge of the clinical course and recurrence of mood disturbances.
