Mania & BPD
by Sydney Rudd
1. BPD (bipolar disorder)
1.1. High prevalence, 5-10% population
1.1.1. Common psychiatric disorder
1.1.2. only 2% modern diagnoses would've been diagnosed as BPD 30 y/a
1.2. Mild severity - treated out of hospital
1.3. Diagnosis from 1 week of hospital admission
1.4. Old diagnosis
1.4.1. BPD = manic disorder
1.4.2. Prevalence was rare, only 0.1% population treated in hospital for BPD
1.5. Can be diagnosed in children / teens // manic depression = just adults
1.5.1. Children / teens can grow out of it - period of turmoil is normal
2. Bipolar 1 & Bipolar 2
2.1. Separate disorders, not varying levels of severity
2.2. Bipolar 1
2.2.1. Rare & severe
2.2.2. Equivalent to older cases of manic depression
2.3. Bipolar 2
2.3.1. More commonly diagnosed
2.3.2. 90% Bipolar diagnoses = BPD2
2.3.3. Combination of mixed diagnoses
2.3.3.1. High trait neuroticism, unstable emotions / mood swings
2.3.3.2. Major depressive disorder, high mood, energetic, talkative
2.3.4. Drug effects can cause BPD2
2.3.4.1. Side effects / withdrawal
2.3.5. Respond to sedation
3. Diagnosis
3.1. Cocktail of drugs
3.1.1. Change behaviour from destabilising the brain
4. Stephen Fry - BPD
4.1. Does cocaine (destabilises the brain)
4.2. DSM states that BPD shouldn't be diagnosed in cocaine users
5. Hypomania & mania
5.1. Hypomania = level below complete mania
5.1.1. Severe w/ psychotic symptoms, e.g. hallucinations, delusions, thought disorder & catatonia - any or all
5.2. Same thing - varying levels of severity
5.3. Mania = psychosis
5.3.1. High mood (ecstatic, happy, angry, etc.) Irritable Overactive / over talkative
5.4. NO insight
5.4.1. Difficult to treat - not aware they're ill
5.4.2. Brought into hospital against their will
5.4.3. Generally feel fine / better than fine
6. Features of mania
6.1. High energy, never tired (hyperactive)
6.1.1. Don't want or need sleep
6.2. Speech fast & loud - can't be interrupted
6.3. Poor attention, easily distracted
6.4. "Grandiose"
6.4.1. Inflated self-esteem
6.4.2. Think they're very powerful / important
6.5. Reckless / impulsive behaviour
6.5.1. Destructive - prison, addiction or overspend in periods of mania
6.5.2. Includes suicide
6.5.2.1. Crash from high to low & act before they think
7. Psychotic features of mania
7.1. Hallucinations
7.1.1. Voices, mood congruent
7.2. Delusions
7.2.1. False beliefs, also mood congruent
8. Outcomes
8.1. Impulsivity --> destruction
8.2. Used to die from exhaustion when untreated
8.3. Hospital treatment compulsory to prevent suicide / exhaustion due to lack of insight
9. Treatment
9.1. Emergency sedation
9.1.1. BZs - lorazepam or antihistamines - promethazine
9.1.1.1. Powerful sleeping agent
9.2. Antipsychotics / neuroleptics
9.2.1. Tranquilizers - chlorpromazine
9.2.1.1. Demovtivate
9.2.1.2. Blunt emotions
9.3. ECT
9.3.1. Last resort // highly effective
10. Preventative treatment
10.1. Main treatment WAS lithium - given as carbonate ion to prevent mania
10.1.1. // side effects & difficult to find right dosage
10.2. Now given cocktail of drugs (antipsychotics) to prevent highs & lows
10.3. Anticonvulsants common
10.3.1. All major classes of psychiatric drugs taken = long-term damage
10.3.2. Must cope with side effects & interactions between drugs
10.3.3. Chase side effects not symptoms