Bipolar

Question 1

How is a manic episode diagnosed?

Answer 1

1- at least 1 week of mood disturbance -> characterized by elated, irritable, or expansive mood
2- 3 or more of the following symptoms are present
- grandiosity - inflates self esteem
- sleeps very little
- very talkative
- racing thoughts or flights of ideas
- distractibility
- increased level of goal-focused activity at home, at work, or sexually
3- mood disturbance is severe enough to cause impairment of function & hospitalization
4- mood is not the result of substance abuse or a medical condition

Question 2

How can we differentiate a manic episode from a hypomanic one?

Answer 2

Hypomanic episode

• 4 days
• symptoms like MANIA but no impairment of function
• observed by others
• represents change from self
• no need for hospitalization

Question 3

How high is the suicide rate in bipolar?

Answer 3

• more in males
• suicide rate is 15% in depressive state usually
• 70% present in depressive state
• conversion from MDD is 5-10%

Question 4

Why is bipolar disorder so important to distinguish?

Answer 4

because 2/3 of patients are misdiagnosed initially because

• people don’t remember their hypomanic/manic symptoms
• usually seek treatment in depressive episodes
• doctors miss taking collateral history

Question 5

How is bipolar disorder managed?

Answer 5

treatment is lifelong

• hypomania: outpatient
• Mania: hospitalization due to
• > marked overactivity / disturbed behavior
• > poor compliance
• > absent family support

Question 6

What are the medications used for treatment of bipolar?

Answer 6

combination of mood stabilizers & atypical antipsychotics (in case of agitation use Benzos)

DEPRESSION mood stabilizers

• Lithium
• Lamotrigine

MANIC/HYPOMANIC antipsychotics
- quetiapine

Question 7

What are the guidelines for doctors to follow in case of bipolar?

Answer 7

Search for features of Mania

• irritable/expansive mood
• sleep too little
• high energy level
• talks too much
• psychotic symptoms
• impairment of judgement