Bipolar disorder Flashcards
How can mania affect mood?
Irritability
Euphoria
Lability (constantly changing)
How can mania affect cognition?
Grandiosity Poor concentration Flight of ideas/racing thoughts Confusion Lack of insight
How can mania affect behaviour?
Rapid speech Hyperactivity Reduced sleep Hypersexuality Extravagance
Which psychotic symptoms may mania present with?
Delusions
Hallucinations
What medications can cause mania?
Steroids
Illicit substances (amphetamines, cocaine)
Antidepressants
What diseases can cause mania?
Infection Stroke Neoplasm Epilepsy MS Hyperthyroidism
How do you treat acute moderate/severe mania?
Second-generation antipsychotic or sodium valproate
How do you manage bipolar disorder?
Mood stabaliser for longer term control:
Lithium carbonate
CBT
What are the conditions for lithium treatment?
Good compliance
Normal U&Es, ECG and T4
What plasma level of lithium are you aiming for when treating bipolar disorder?
0.6-1 mmol/L
How often should lithium levels be checked?
Weekly until dose has been constant for 4 weeks
Monthly for 6 months
3 monthly if stable
What can affect lithium levels?
Diuretics NSAIDs ACE-i Low salt diet Pregnancy
What other monitoring should be done when a patient is on lithium and why?
U&E: nephrogenic diabetes insipidus
TSH: hypothyroidism
How is lithium teratogenic?
Risk up to 12% for Ebstein anomaly, floppy baby syndrome, thyroid abnormality
What medications can be used when lithium doesn’t control bipolar?
Anticonvulsants (Na valproate or carbamazepine)
Antipsychotics
Combination treatments
Antidepressants + lithium
