Bipolar affective disorder

Question 1

What is bipolar affective disorder?

Answer 1

A psychiatric disorder characterised by periods of mania/hypomania and depression

Question 2

When does bipolar disorder typically develop?

Answer 2

Late teens

Question 3

What are the two types of bipolar disorder?

Answer 3

Type 1 - mania and depression
Type 2 - hypomania and depression

Question 4

Which type of bipolar disorder is most common?

Answer 4

Type 1 - mania and depression

Question 5

What are the risk factors for bipolar disorder?

Answer 5

Genetics
Physical illness
Stressful life events
Substance misuse

Question 6

What is mania?

Answer 6

Severe functional impairment and psychotic symptoms for 7 or more days, with at least 3 associated symptoms

Question 7

What is hypomania?

Answer 7

Less severe than mania - similar to mania but with no functional impairment, and no psychotic symptoms

Question 8

What are the signs and symptoms of a depressive phase of bipolar?

Answer 8

Tearfulness
Anhedonia
Suicidal ideation or attempts
Withdrawal
Low mood
Poor sleep

Question 9

What are the signs and symptoms of a manic phase of bipolar?

Answer 9

Elevated mood
Irritability
Impulsivity
Reduced need for sleep
Flight of ideas
Mood congruent delusions

Question 10

What are the differential diagnoses of bipolar disorder?

Answer 10

Major depressive disorder
Schizoaffective disorder
Generalised anxiety disorder
Substance induced mood disorder

Question 11

What is the DSM-5 criteria for diagnosis of bipolar disorder?

Answer 11

Mania - 7 day episode of functional impairment and psychotic symptoms (3 associated symptoms needed)
Hypomania - 4 day episode with features similar to mania (bit no functional impairment or psychotic symptoms)
Depression - one episode of major depression lasting 2 weeks (with 4 associated symptoms)

Question 12

What is the treatment of acute mania with agitation?

Answer 12

IM neuroleptic or benzodiazepine (olanzapine or haloperidol)
Admission to secure unit

Question 13

What is the treatment of acute mania without agitation?

Answer 13

Oral antipsychotic monotherapy
(+ sedatives)

Question 14

What is the treatment of acute depression in bipolar?

Answer 14

Mood stabiliser, antidepressant or atypical antipsychotic
Psychosocial support

Question 15

What is the long term management of bipolar disorder?

Answer 15

Mood stabilisers - lithium or valproate
CBT, interpersonal therapy or family therapy

Question 16

What are the side effects of litium?

Answer 16

Dry mouth
Fine tremor
GI disturbance
Increased thirst
Increased urination
Drowsiness
Thyroid dysfunction

Question 17

What are the symptoms of lithium toxicity?

Answer 17

Coarse tremor
Seizures
Dysarthria
Impaired coordination
Cardiac arrhythmias
Visual disturbance

Question 18

What is the gold standard investigation for lithium toxicity?

Answer 18

Serum lithium levels

Question 19

What other investigations can be performed to help diagnose lithium toxicity?

Answer 19

U&Es
TFTs
Renal function
ECG

Question 20

Which antipsychotics are most typically used in the treatment of mania?

Answer 20

Haloperidol
Olanzapine
Quetiapine
Risperidone

Question 21

What is the first line long term management of bipolar?

Answer 21

Lithium

Question 22

What is the second line long term management of bipolar?

Answer 22

Add valproate/lamotrigine as an adjunct to lithium

Question 23

What other medications can be used as mood stabilisers?

Answer 23

Carbamazepine
Olanzapine

Question 24

When should lithium levels be monitored after a change in dose?

Answer 24

1 week after dose change and then every week until levels are stable