Bipolar disorder Flashcards
Definition of bipolar disorder?
Episodic depressed/elated moods with increased activity (mania/hypomania)
Difference between mania and hypomania?
Hypomania has no psychotic features and is usually not severe enough to cause marked functional impairment or require hospitalization
Definition of rapid cycling bipolar disorder?
At least 4 manic/hypomanic/depressed/mixed episodes within 12 months
Initial management of suspected bipolar disorder in GP?
Referral to psychiatry; urgency depending on risk assessment
Chronic disturbance of mood consisting of periods of subclinical depression and hypomania
Cyclothymia
Auditory hallucinations in bipolar vs schizophrenia?
Bipolar more often second person (i.e. talking directly to them), schizophrenia more often 3rd person (e.g. a running commentary)
Drugs/substances which may mimic mania?
Cocaine, ecstasy, amphetamines
Organic brain disease which may mimic bipolar? (5)
Frontal lobe dementia Multiple sclerosis Epilepsy Encephalitis Space-occupying lesion
Iatrogenic mimics of bipolar? (4)
Corticosteroids
Dopamine agonists e.g. pramipexole, levodopa
Prescribed stimulants e.g. methylphenidate
Antidepressants
DVLA guidance during acute mania?
Should stop driving; need to contact DVLA; insurance may not be valid if they continue to drive
Management of acute mania?
Therapeutic trial of oral antipsychotic; tapering of antidepressant
First-line treatment for prevention of relapse in bipolar disorder?
Lithium
Second-line, if lithium is a) ineffective b) not tolerated?
a) add valproate
b) valproate or olanzapine monotherapy
Important considerations with valproate?
Teratogenic; avoid in women of child-bearing age if able, and ensure adequate contraception if not
Lithium monitoring a) Levels b) other monitoring
a) Weekly levels until dose is constant for four weeks; then monthly for 6 months; then 3 monthly
b) 6 monthly U&Es, TFTs