Bipolar Disorder

Question 1

What is bipolar disorder

Answer 1

A cyclical mood disorder that involves episodes of disruption to mood and behaviour, interspersed with periods of recovery

Split into: Depressive or manic episodes

Question 2

What are the treatment aims of bipolar disorder

Answer 2

Control manic and depressive attacks

Minimise recurrence and stabilise mood

Question 3

What are the symptoms of bipolar disorder

Answer 3

1. Manic episodes: patient has increased energy, decreased need for sleep, short attention span, inflated self esteem, can include hallucinations or excessive motor activity. Must happen for 7 days
2. Hypomanic episodes: similar to mania but irritability, boorish behaviour. Must happen for 4 days
3. Depressive episodes: low mood, low energy, decrease enjoyment in activities, reduced self esteem- must have it for four days

Question 4

What are the causes of bipolar disorder

Answer 4

1. Genetic components and structural brain differences (family history)
2. Aetiology: monoamine therapy that suggests a lack of monoamine neurotransmitters (serotonin, noradrenaline, dopamine)

Question 5

How do you diagnose bipolar disorder

Answer 5

1. DSM V: recognises biopolar disorder 1 and 2

Bipolar disorder 1: least one manic episode

Bipolar disorder 2: One major depressive illness and one hypomanic episodes

2. ICD-10 experience of at least two mood episodes: must be one of mania or hypomania

Question 6

How do you manage bipolar disorder, drug treatments?

Answer 6

1. Initial psychological factors are taken into place using CBT to improve clinical outcomes
2. Manic or hypomanic episodes: managed with short term pharmacological treatments:
   Antipsychotics: Haloperidol, olanzapine, quetiapine and risperidone (1st line)

Lithium or valproate (2nd line)

Question 7

How do you treat bipolar depression

Answer 7

1. CBT
2. Fluoxetine: only antidepressant that can be used in combination with atypical antipsychotics (olanzapine)
3. Quetiapine, lamotrigine

Question 8

How do you treat bipolar disorder on the long run (prophylaxis)

Answer 8

Lithium

Question 9

Describe Lithium treatment, monitoring, mechanism of action, side effects, drug interactions

Answer 9

1. Taken for life, Narrow therapeutic window, monitor renal, thyroid, has teratogenic effects
2. Mechanism: alters monoamine levels and modifies Na+ channel activity

3. Side effects: 
Anorexia, Nausea, vomiting and diarrhoea
Hypotension, arrhythmia, circulatory failure
Polyuria
Fine tremor, muscle weakness 
Convulsions, coma 

4. Drug interactions:
   Increase levels: ACE inhibitors, diuretics, NSAIDs, topiramade
   Decrease levels: Theophylline, high sodium

Question 10

If patients are unresponsive to lithium what do you use

Answer 10

Anti-epileptic drugs
Valproate
Carbamazepine
Topiramate

Question 11

What is the mode of action of valproate and give examples of valporates

Answer 11

Inhibitory action of gamma amino butyric acid (GABA) in the brain

Examples: Lamotrigine, Sodium Valporate