Bipolar affective disorder

Question 1

What is bipolar affective disorder (the sum of)?

Answer 1

Depression and mania (type 1) or hypomania (type 2)

Question 2

Bipolar I is

Answer 2

Manic episodes which are severe and lead to impaired functioning which may be interspersed major depressive episodes

Question 3

Bipolar II is

Answer 3

Hypomania - not full mania, has no psychotic symptoms and less dysfunction, often interspersed with depressive episodes

Question 4

What are the Manic phase symptoms

Answer 4

Elevated mood and psychomotor activity

Grandiosity/inflated self-esteem.
Decreased need for sleep.
Pressured speech.
Flight of ideas (rapidly racing thoughts and frequent changing of their train of thought).
Distractibility.
Psychomotor agitation.
Excessive involvement in pleasurable activities without thought for consequences (eg, spending spree resulting in excessive debts).

Severe - auditory hallucinations, delusions of persecution, lack of insight

Question 5

Name Hypomanic phase symptoms

Answer 5

persistent mild elevation of mood and increased activity and energy but without hallucinations or delusions

Question 6

Management of bipolar affective disorder- non pharmacological

Answer 6

Psychological therapies - CBT
Education
Support groups

Question 7

Acute pharmacological management (for mania/hypomania)

Answer 7

Anti-psychotic
haloperidol, olanzapine, quetiapine or risperidone
If already taking one - maximise the dose or try another one
If the second drug is ineffective - add lithium
If lithium isn’t appropriate - add valproate (teratogenic)

Benzodiazepines for rapid tranquillisation if required

Question 8

Long term treatment of bipolar affective disorder

Answer 8

Lithium - first line (mood stabiliser)
Add valproate/olanzapine if ineffective
[Next try lamotrigine or carbamazepine]

CBT, education etc good

Question 9

Lithium use and drawbacks

Answer 9

Mood stabiliser (decreases noradrenaline increases serotonin)
Requires monitoring - hypothyroidism risk

Teratogenic

Question 10

what is Cyclothymia?

Answer 10

Milder form of bipolar

Question 11

Lithium toxicity

Answer 11

[above1.5] Anorexia, diarrhoea, vomiting
Drowsy, restless
Slurred speech (dysarthria)
Dizzy
coarse tremor

Severe: [above 2.0]
convulsions, collapse, coma
hypokalaemia, renal failure

Question 12

Lithium side effects

Answer 12

abdominal pain
nausea
metallic taste 
fine tremor
thirst/polyuria
weight gain/oedema