Bipolar disorder

Question 1

What is bipolar disorder

Answer 1

Bipolar 1
Mania (for 1 wk at least) f/b depression
Bipolar 2
Hypomania and depression

Mean age - 18yrs
Heredity ++

Question 2

DSM criteria for Mania

Answer 2

Episode for 1wk or more
DIGFAST
Distractability - poor focus, multitasking
Insomnia
Grandiosity, inflated self esteem
FLIGHT OF IDEAS
Activities - goal directed
Speech - pressured, talketive
Thoughtlessness - risk taking (sexual, driving, financial,travel)

Question 3

Mx of bipolar disease

Answer 3

1. Hospitalisation
2. involuntary admission
3. Antipsychotics
   First line: Olanzepine/Resperidone (atypical AP)
   Second line:
   Haloperidol
   Aripiprazole (D2 agonist but weaker than dopamine)
   Lithium

Mood stabilizers:
Carbamazepine/Sodium valproate

Parenteral:
Haloperidol IV/IM

Question 4

Target plasma level for lithium

Answer 4

0.6-0.8 mmol/l

Question 5

Cyclothymia, Mx

Answer 5

Depressive mood f/b hypomania, many cycles
For >2yrs

Mx: Mood stabilisers
1. lithium
2. Carbamazepine
3. Sodium valproate