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 (thought disorder/delusions/hallucinations)

Question 4

Who should you refer to and how urgent?

Answer 4

All people with mania will need a specialist mental health review - they cannot be managed in primary care

Hypomania- NICE recommend ROUTINE referral to the community mental health team (CMHT)

Mania/severe depression then an URGENT referral to the CMHT should be made

Question 5

Management of an episode of mania / BAD (elated)

Answer 5

ELATED MANIA MANAGMENT

1. Stop antidepressants if on
2. Treatment with ANTIPSYCHOTIC (haloperidol, olanzapine, quetiapine, or risperidone)
3. If not effective after 2-3 weeks, try another antipsychotic
4. If thats not effective add lithium (or valporate but not if premenopausal woman)

**if already on lithium or valproate > increase dose

Question 6

What is the treatment for depression in BAD?

Answer 6

Depressive episode of BAD

1st line
Olanzopine + Fluoxitine
OR
Quetiapine

2nd line
Lamotragine

**if already on lithium or valproate >increase dose

Question 7

What is long term treatment of BAD?

Answer 7

FOR LONGER-TERM MANAGEMENT

• 4 weeks after mania has resolved they should receive review from psychiatric services
• LONG TERM ANTIPSYCHOTIC AND MOOD STABILISER (Li or Valporate (Depakote))

Psychological therapies should also be offered
○ CBT/ talking therapy to recognise triggers and signs

Question 8

How do you get a diagnosis of BAD?

Answer 8

Diagnosis

• have to have 2 episodes of seriously disturbed mood (one of which mania/hypomania).
• Important to remember that patients with manic or hypomanic episodes can still be diagnosed with BAD even in the absence of depressive episodes.