Bipolar Affective Disorder

Question 1

What is the prevalence and the average age of onset?

Answer 1

Prevalence = 1%. Average age of onset is 21y

Large genetic component - large degree of concurrence between monozygotic twins (79%)

Question 2

ICD-10 Criteria for BAD

Answer 2

• Elated mood, irritable or mood lability
• Increased energy levels or hyper-activity
• Distractibility, reduced concentration or constant changing of plans
• Perceived reduced NEED for sleep (common)
• Inflated self-esteem - delusions of grandiosity
• Overfamiliarity / disinhibition
• Reckless behaviour / overspending
• Increased sex drive
• Fleeting thoughts - flight of ideas
• Psychotic symptoms

Usually have to have two episodes of seriously disturbed mood in the last 6 months and one doesn’t have to be depression

Question 3

Difference between mania and hypomania

Answer 3

MANIA IS HYPOMANIA BUT WITH PSYCHOTIC SYMPTOMS

Question 4

Management of an episode of mania / BAD

Answer 4

All people with mania will need a specialist mental health review - they cannot be managed in primary care
During the acute phase people can be offered:
- THERAPEUTIC TRIAL OF A/P:
haloperidol. onlanzapine, risperidone
Then trial a second one if this doesn’t work
THEN trial LITHIUM

FOR LONGER-TERM MANAGEMENT
- MOOD STABILISERS: Li and VALPROATES (Depakote)

Then 4 weeks after mania has resolved they should receive review from psychiatric services (long-term anti-psychotic and lithium therapy)

Psychological therapies can be offered e.g. lithium