Bipolar

Question 1

How would you define bipolar affective disorder?

Answer 1

Periods of prolonged depression alternate with periods of excessively elevated mood

Question 2

Name some key symptoms which constitute mania

Answer 2

– Elevated mood
– increased energy
– lack of concentration
– less need for sleep
– inflated self-esteem (grandiosity)
– reckless behaviour
– increase libido
– pressured speech/racing thoughts
– psycho motor agitation
– Irritatability/aggressive
– disinhibition

Question 3

For mania to be diagnosed, how long should the symptoms last for and how many symptoms need to be present?

Do the symptoms begin abruptly or insidiously?

Answer 3

Three symptoms are needed
For at least one week
Symptoms come on abruptly

Question 4

How would you describe hypomania, including how long symptoms should last for?

Answer 4

Symptoms of mania, but not to the extent that they have severe effects on occupation or social rejection
There are no psychotic symptoms
Symptoms for four days

Question 5

How long do you episodes usually last for in bipolar affective disorder?
How many episodes with someone expect to experience in the lifetime?

Answer 5

Episodes last for about four months and a person can expect to have around 10 episodes in a lifetime however this varies between individuals

Question 6

How would you describe bipolar disorder type one

Answer 6

The presence of mania with or without depression

Question 7

How would you describe by Bipolar affective disorder Type II

Answer 7

Hypo mania with depression

Question 8

Describe the epidemiology of bipolar affective disorder

Answer 8

Effect 1% of the population

Males equals females

Question 9

Describe the aetiology behind bipolar affective disorder

Answer 9

– Genetics
One of the most inheritable psychiatric disorders
If first-degree relatives are affected this increases the risk by five times
There are a number of small risk alleles
– Environmental triggers
Early life stress, maternal death before five years of age, abuse, neglect, childhood trauma
Toxoplasma Gondi exposure
Cannabis/cocaine use

Question 10

What is the neurochemical theory behind bipolar disorder?

Answer 10

The opposite of depression.
There is an elevation in monoamine neurotransmitters
– serotonin, noradrenaline and dopamine

Question 11

What questions could you ask to distinctly decipher between depression and bipolar disorder?

Answer 11

– Have you ever experienced a mood that is higher than normal, or do you feel much more irritable than usual/have others noticed?
– At the same time do you have increased energy levels?
– Are you more active
– do you find that less sleep is necessary

Question 12

Our clinical tests necessary for a diagnosis of bipolar disorder? If so which ones would you do

Answer 12

You should use clinical judgement to determine whether clinical tests are necessary the diagnosis.
Tests and you could do including FBC, TFT, toxicology screen, vitamin di

Question 13

Where does most initiated treatment for bipolar occur?

Answer 13

In secondary care

Question 14

How would you treat mania acutely in secondary care?

In a patient with bipolar affective disorder

Answer 14

You would give them an antipsychotic
Haloperidol, risperidone, Quetiapine or olanzapine

If the First Antipsychotic drug is not affective, try another from the list
If the second antipsychotic drug is ineffective, try adding lithium or if lithium is inappropriate add valproate

Question 15

How would you treat depression in secondary care, in a patient with bipolar affective disorder?

Answer 15

Olanzapine
Quetiapine
Fluoxetine and olanzapine
Lamptrigine

Question 16

What is the long-term management in a patient with bipolar affective disorder

Answer 16

Continue on the antipsychotics Used to treat mania. Or
Start long-term lithium, if lithium is ineffective add valproate. If lithium is contra indicated can use valproate alone or olanzapine alone

Psychological intervention for bipolar
CBT
Monitor symptoms and secondary care for 12 months

Question 17

Bipolar patients often make a care plan, what does this mean?

Answer 17

– Crisis plan
– warning symptoms and triggers the mania and depression
– medication plan and review dates
– advanced statement on treatment in case they lose capacity

Question 18

How can bipolar patients prevent relapse?

Answer 18

– Compliance with medication
– good sleep
– avoid nighttime activities
– regular morning routine
– avoid caffeinated drinks
– stop or cut down on smoking and avoid alcohol and drugs

Question 19

At a physical health review for patients with bipolar affective disorder, what would you want to?
What investigations which you need to do?

Answer 19

Discussed stopping smoking, discuss diet and activity levels
Measure weight and waist to conference
Measure pulse and blood pressure
Measure fasting blood glucose, HB A1 C, lipids, u+e’s, FBC, LFT,
TFT and calcium in patients taking long-term lithium