5. Bipolar

Question 1

What is the peak age of onset of bipolar disorder?

Answer 1

15-19 years

Question 2

What is the difference between mania and hypomania?

Answer 2

Hypomania - symptoms of mania that don’t cause a marked impairment in social or occupational function and NO psychotic features. Hypomania can be diagnossed if symptoms last >4 days. Manic episode requires >7 days.

Psychotic features: delusions or hallucinations.

symtomps of depression not required for diagnosis.
Referral needed for diagnosis

Question 3

Which features MUST be present for bipolar diagnosis in children?

Answer 3

Mania
Euphoria for >7 days
Irritability is NOT a core criterion

Referral needed for diagnosis.

Question 4

What is bipolar II?

Answer 4

one or more major depressive episodes

one hypomanic episode (but no evidence of mania)

Question 5

If someone has acute bipolar presentation (mania or severe depression), what should they be advised on driving?

Answer 5

Stop driving during the acute illness. Their insurance may not be valid if they continue. They must tell the DVLA about their illness once diagnosed.

Question 6

What should a physical health review include for a patient with Bipolar?

Answer 6

• lifetstyle advice
• weight, waist circumference
• Pulse and BP
• fasting glucose, HbA1c
• Lipids
• U&E
• FBC
• LFTs
• TFT and Ca if on lithium

Question 7

Which 4 antipsychotics could be trailled first line in bipolar with mania? (by 2ry care)

Answer 7

• oral haloperidol, olanzapine, quetiapine, risperidone.
• If 1st not worked , another is trialled from this list
• 3rd line, lithium may be added, or valproate if not premenopausal female.

Question 8

What are the medication options for depression in bipolar?

Answer 8

• quetiapine alone
• olanzapine alone
• Lamotrigine alone
• or fluoxetine with olanzapine

Question 9

What psychological interventions can be used in Bipolar?

Answer 9

• one specially developed for bipolar depression
• High intensity CBT