Revise FMGE 2023 syllabus with Kings
As the National Board of Examinations in Medical Sciences (NBEMS) has announced that the Foreign Medical Graduate Examination (FMGE 2023) will be held on July 30, you must be nervous, right? We advise you to prepare for the exam by joining us. You still have time on your hands. FMGE classes are going on fervently at Kings right now. We have invited Dr. Mohan Sunil Kumar for Psychiatry classes for our FMGE students. Learn about ‘Bipolar & Double Depression’ topic with us!
Types of Bipolar
| Bipolar 1 | Bipolar 2 |
| Repeated episodes of: M M+D M+ Hy M+Hy+D |
Hypomania + Depression Mania: Never goes beyond Hypo Depression: Any intensity |
Even if there is single episode of Mania --> Bipolar 1
| Hypomania | Mania |
| Symptoms for >4 days Prolixity of speech Mild Never need admission Seen in: Bipolar 1, 2 |
> 1 week Flight of ideas Moderate to Severe Need admission Seen in: Bipolar 1 only |
1 week: Mania
2 week: Depression
3 week: Anti-depressants effect
4 days: Hypomania
| Dysthymia | Cyclothymia | Chronic major depression |
| PERSISTENT MOOD DISORDER: 2 years | Cycle of active & depressive (minimal level) DOC: Divalproate / Valproate | Chronically depressed for >2 years |
DOUBLE DEPRESSION
A dysthymia patient going onto develop a full flexed depression
Rapid Cycling Disorder:
Type of Bipolar disorder
>/=4 episodes/year (irrespective of type)
Risk factors:
DOC: Divalproate / Valproate
Lithium doesn’t work
Acute Mania:
TOC: Anti-Psychotics
Mood stabilizers: Mainly used for Maintenance /
Lithium
Lamotrigine
Carbamazepine
Valproate
Carb + Valproate -->act in manic phase
Absolutelet C/I in pregnancy: Carbamazepine, Valproate
Can be given, but avoided for best: Lithium
Gold standard mood stabilizer: Lithium
Long term use can cause --> hypothyroidism
Can also cause: Diabetes Insipidus kind of Nephropathy
Tremors: Both Fine (Benign) and Coarse (Malignant)
Mx of bening tremors → Beta blockers, THP
Coarse tremors → indicate Lithium toxicity
Lithium toxicity:
Management of Bipolar disorder:
Psychological intervention → IPSRT (Inter Personal Social Rhythm Therapy)