Bipolar affective disorder

Question 1

Type 1

Answer 1

Mania and depression (most common)

Question 2

Type 2

Answer 2

Hypomania and depression

Question 3

Difference between mania and hypomania

Answer 3

Mania: >7 days, psychotic symptoms (delusions of grandeur or auditory hallucinations)

Hypomania: 4-7 days, no psychotic symptoms

Question 4

Management

Answer 4

Psychological interventions

Lithium is mood stabiliser of choice (valproate is an alternative)

Question 5

Management of mani/ hypomania

Answer 5

Consider stopping antidepressant if the patient takes one

Antipsychotic therapy (olanzapine or haloperidol)

Question 6

Management of depression

Answer 6

Talking therapies

Fluoxetine is antidepressant of choice

Question 7

Address co-morbidities

Answer 7

2-3x increased risk of diabetes, CVD and COPD

Question 8

Primary care referral

Answer 8

If symptoms suggest hypomania NICE recommend routine referral to the community mental health team

If features of mania or severe depression then urgent referral to CMHT