Bipolar Disorder

Question 1

What are the symptoms of mania?

Answer 1

• Grandiose delusions
• Flight of ideas
• Pressured speech
• Irritability
• DIG FAST = distractibility, irresponsibility, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness

Question 2

What is the difference between mania and hypomania?

Answer 2

• Mania: severe functional impairment or psychotic symptoms for >/= 7 days
• Hypomania: describes decreased/increased function for >/= 4 day, but not severe enough to impair day to day (in type 2 potentially just 1 episode of this, then major depression)
• Key differentiation is psychotic symptoms (e.g. delusions of grandeur or auditory hallucinations) which suggest mania

Question 3

What is type 1 bipolar disorder?

Answer 3

Mania and major depression (>/= 2 weeks)

Question 4

What is type 2 bipolar disorder?

Answer 4

Hypomania and major depression (>/= 2 weeks)

Question 5

What are the symptoms of hypomania/mania?

Answer 5

• Mood - mainly elevated and irritable
• Speech + thought - pressured, flight of ideas (jumps topics based on association), poor attention
• Behaviour: insomnia, loss of inhibitions, sexual promiscuity, overspending, risk-taking, increased appetite, poor decision making, delusions of grandeur

Question 6

What are the symptoms of depression?

Answer 6

• Hopeless and discouraged
• Lack of energy and focus
• Physical symptoms (eat and sleep little)

Question 7

What is the timeline of bipolar episodes?

Answer 7

• Mixed episodes: symptoms of depression and mania at same time
• Rapid cycling: >/= 4 episodes of depression or mania within a year

Question 8

What is the management for bipolar?

Answer 8

• Psychological interventions
• Depression management: talking therapies, CBT, 1st line antidepressant is fluoxetine
• Address co-morbidities: 2-3x increased risk of diabetes, CVD and COPD

Question 9

What is the pharmacological management of bipolar?

Answer 9

• 1st line is lithium as a mood stabiliser
• 2nd line is sodium valproate
• Management of mania: consider stopping antidepressant if patient taking one - antipsychotic therapy e.g. olanzapine, haloperidol

Question 10

What is done for a primary care referral in mania/hypomania?

Answer 10

• If symptoms suggest hypomania NICE recommends routine referral to community mental health team (CMHT)
• If there are features of mania or depression then an urgent referral to CMHT to be made