Bipolar Affective Disorder Flashcards
Define Bipolar Affective Disorder?
Fluctuations of depression and mania over weeks
What age does it typically present?
<25 yrs olds, mean = 21
How to diagnose bipolar? (3)
1 episode of mania with or without depression
1 episode of hypomania with depression
OR
recurrent episodes of mania
What is rapid cycling?
> or equal to 4 episodes of mania, hypomania +/- depression within 1 year
Investigations?
8
Urine +/- serum drug screen, FBC, LFT’s, U&E’s, TFTs, ESR, pregnancy test, urine test
1st line medical Mx of Bipolar Manic episode?
Atypical A/P e.g. olanzapine/risperodone - increase to max dose if already taking
If that is ineffective?
Add lithium
When is lithium inappropriate to administer? (1)
If it cannot be regularly monitored
What can be given if lithium can’t be? When can this not be given?
Semisodium valproate
Women of child bearing age
What drug must be stopped if a bipolar manic episode occurs?
anti-depressant
What is the first thing that need to done in Mx of Depressive episode?
Risk assessment
What is the medical Mx?
A/D with anti-manic therapy (i.e. A/P), e.g. fluoxetine with olanzapine
1st line Medical maintenance Mx for BAD?
Lithium
2nd line? (2)
Valproate or Olanzapine
If there are persistent symptoms? (2)
Lamotrigine
Carbamazepine
BZD - sedation
