Bipolar disorder

Question 1

1st line drug treatment for Mania

Answer 1

Antipsychotics

• haloperidol
• olanzapine
• risperidone
• quetiapine

Question 2

2nd, 3rd and 4the line of drug treatment of Mania

Answer 2

2nd line: alternative antipsychotic

3rd line: Lithium

4th line: Na Valporate

Question 3

what is bipolar disorder?

Answer 3

condition characterised by manic/hypomanic + depressive episodes

Question 4

type 1 criteria

Answer 4

at least 1 episode of mania which lasts longer than a week

may have experienced depressive episodes

Question 5

type 2 criteria

Answer 5

you have experienced both

• 1 episode of severe depression
• symptoms of hypomania

Question 6

signs of mania in mood (3)

Answer 6

• irritability
• euphoria
• lability

Question 7

signs of mania in cognition (5)

Answer 7

• grandiosity
• poor concentration
• flight of ideas
• confusion
• lack of insight

Question 8

signs of mania in behaviour (3)

Answer 8

• reduced sleep
• hypersexuality
• hyperactivity

Question 9

signs of mania in psychotic symptoms (2)

Answer 9

• delusions

- hallucinations

Question 10

hypomania is ___

Answer 10

less severe symptoms of mania, without psychosis

Question 11

Causes

Answer 11

• childhood trauma
• stressful life events
• genetics
• medications
• organic causes

Question 12

how frequently should Lithium levels be checked

Answer 12

• weekly initially, until the dose has has been constant for 4 weeks
• then monthly for 6 months
• then 3 monthly if stable

Question 13

signs of lithium toxicity

Answer 13

• reduced vision
• D + V
• hypokalaemia
• ataxia
• coarse tremor
• dysarthria
• coma
• hyperreflexia

Question 14

management of depressive episodes

Answer 14

• fluoxetine

- CBT

Question 15

management of hypomanic/manic episodes

Answer 15

• antipsychotic: haloperidol/olanzapine

- Lithium

Question 16

what can Lithium be effective for?

Answer 16

decreasing the likelihood of:

• mania
• recurrent depression
• further mood episodes
• suicidal feelings

Question 17

what is the narrow therapeutic range of Lithium

Answer 17

0.4 to 1.0 mmol/L

Question 18

how often is the thyroid and renal function checked in patients taking Lithium

Answer 18

every 6 months

Question 19

concentration of lithium at lithium toxicity

Answer 19

> 1.5 mmol/L

Question 20

precipitating factors for Lithium toxicity

Answer 20

• dehydration
• NSAIDs
• renal failure
• diuretics (espec. bendroflumethiazide)
• metronidazole

Question 21

3 steps of management for Lithium toxicity

Answer 21

1. volume resus w/ normal saline
2. Haemodialysis
3. Sodium Bicarb