Bipolar Affective Disorder

Question 1

define bipolar affective disorder

Answer 1

recurrent illness with periods of alternating abnormal mood elevation and depression
elevation is either hypomania or mania

Question 2

for a diagnosis of hypomania, how many days must symptoms be present for

Answer 2

at least 4 days

Question 3

outline some of the features of hypomania

Answer 3

increased activity 
increased talkativeness 
distractability 
decreased need for sleep 
increased sexual energy 
mild spending sprees/reckless behaviour

Question 4

for a diagnosis of mania, how many days must symptoms be present for

Answer 4

at least a week, usually requires hospital admission

Question 5

outline some of the features of mania

Answer 5

pressure of speech when talking
flight of ideas 
loss of normal social inhibitions 
decreased need for sleep 
inflated self-esteem and grandiosity 
distracted 
sexual indiscretion 
risky behaviour when driving or spending

Question 6

when is the peak onset of bipolar

Answer 6

in late teens early twenties

increased risk if family history

Question 7

which genetic condition has a strong association with bipolar

Answer 7

Di George syndrome

Question 8

what are some of the differential diagnoses for bipolar

Answer 8

organic cause - hyperthyroid, brain tumour, epilepsy

drug induced - levodopa, antidepressants

Question 9

describe type 1 bipolar

Answer 9

one episode of mania +/- depression

Question 10

describe type 2 bipolar

Answer 10

at least one episode of hypomania + one major depressive episode

Question 11

describe rapid cycling bipolar

Answer 11

4 or more episodes of mood disturbance within 1 year

Question 12

outline the components of the mental state examination and the findings associated with bipolar

Answer 12

appearance - bright, provocative clothing, dishevelled
behaviour - hyperactive/sexual, overfamiliar, distracted
speech - rapid, pressure of speech
mood - euphoria
perception - hallucinations of special power
thought - delusions of grandiosity
cognition - poor concentration and confusion
insight - lack of insight

Question 13

what is the first line treatment for acute mania

Answer 13

hospital admission - give oral anti-psychotics such as olanzapine and risperidone

Question 14

why is lithium not the first line treatment for acute mania

Answer 14

takes a week to become effective, can be added if the antipsychotic response is insufficient

Question 15

what is the first line management fo bipolar long term

Answer 15

lithium

Question 16

what are the second line managements for bipolar

Answer 16

other mood stabilisers such as lamotrigine, valproate and carbamazepine

Question 17

when is lithium contraindicated as a management for bipolar

Answer 17

in pregnancy/breast feeding - give lamotrigine instead

Question 18

describe the monitoring required with lithium

Answer 18

after a dose change, lithium levels are checked weekly to assess for toxicity, once stable they are checked every 3 months

Question 19

what are the side effects of lithium

Answer 19

fine tremor
weight gain 
QT prolongation
dry/metallic mouth
hypothyroidism 
reduced renal function

Question 20

what are the signs of lithium toxicity

Answer 20

D&V
coarse tremor 
drowsiness 
seizures 
electrolyte imbalance 
arrhythmias