Bipolar affective disorder BB Flashcards
What section is used by police to remove someone from public place likely suffering from acute MH crisis?
Section 136
Presentation of mania
- A&B - flamboyant, revealing clothing, irritable, psychomotor agitation, over familiar
- Speech - pressured, difficult to interrupt, loud, excessive
- Mood - excessively happy or excitable, irritable or easily angered
- Thoughts - formal thought disorder (flight of ideas), racing thoughts, grandiose, persecutory beliefs, harm to self/others secondary to delusions, delusions mood congruent
- Perceptions - less common
- Insight - diminished
Advice re sertraline and bipolar affective disorder
- Sertaline can trigger mania episode in BAD - risk of manic-switch with people with BAD
- Important to stop SSRI
- Mood stabiliser can replace (eg lithium)
- If low mood recurrs, reconsider mood stabiliser choice or antidepressants alongside mood stabiliser (to protect against future manic episodes)
Monitoring required for lithium
- U&E - eGFR - excreted only renally, monitor 3-6monthly - can lead to CKD and nephrogenic diabetes insipidus (polydipsia and polyuria)
- TFTs - risk of hypothyroidism - baseline and 6 monthly
- Weight
- ECG - esp if RF for CV disease
- Lithium levels - 1 week after initiating/any changes in dose, measure 12hrs past dose (trough level), once stable level measure less then every 3 monthly
Ideal lithium level and risk if goes too high
- Minimum effective dose - 0.4mmol/L
- Ideal range 0.6-0.8mmol/L
- Up to 1mmol/L in acute mania - above this = danger
- Toxicity definitely occurs at 1.5mmol/L
Other aspects of management after discharge for bipolar affective disorder
- Psychoeducation programme
- Psychological management eg CBT/family therapy
- Ongoing CPN
- Support re benefits/occupational support
Diagnosis criteria for bipolar affective disorder
- At least 2 episodes of affective illness
- One of which is hypomania, mania or mixed
Signs of lithium toxicity
- Tremor
- Anorexia
- N+V
- Diarrhoea
- Dehydration
- Lethargy
- –> CNS effects eg drowsy, muscle weakness, twitching, ataxia –> seizures, coma, death
May need dialysis in severe cases
SSRI that must be used in low doses in elderly
Citalopram - can prolong QTc
Blood tests for Sodium valproate
- LFT
- Before and during first 6 months - due to hepatotoxicty risk
What common drug should you not take alongside lithium without medical advice?
- NSAIDs
- Can increase concentration - need reveiwing
Formal thought disorder commonly associated with mania
Flight of ideas
Pharmacological options for mania
- Lithium
- Olanzapine
- Quetiapine
- Sodium valproate
Example of depressive cognition
Feeling burden on family
Treatment options for resistant depression
- Antidepressant + Mirtazapine
- ECT
- Lithium
- Quetiapine/antipsychotics
Mood stabilisers are not used (other than lithium)
What is CBT NOT used for?
- Catatonic depression
- Delirium
- Hypomania
- Mania
