Bipolar Disorder

Question 1

What are the 2 types of bipolar disorder?

Answer 1

• Type I → mania + depression (most common)
• Type II → hypomania + depression

Question 2

What is the difference between mania and hypomania?

Answer 2

• Both relate to abnormally elevated mood or irritability
• Mania → severe functional impairment or psychotic symptoms for > 7 days
• Hypomania → reduced or increased function for > 4 days
• Key diff is psychotic symptoms (delusions of grandieur or auditory hallucinations) suggest mania

Question 3

What is the management for bipolar?

Answer 3

• Psychological interventions specifically designed for bipolar disorder
• Lithium (1st line) or Valproate (2nd line)
• Manage mania and depression
• Address co-morbidities (2-3x risk of T2DM, CVD + COPD)

Question 4

How do you manage mania in bipolar disorder?

Answer 4

• Consider stopping antidepressant if on one
• Start antipsychotic eg. olanzapine or haloperidol

Question 5

How do you manage depression in bipolar disorder?

Answer 5

• Talking therapies
• First-line → Fluoxetine

Question 6

What are the rules for referral in primary care?

Answer 6

• ?Hypomania → routine referral to CMHT
• ?Mania or ?Severe depression → urgent referral to CMHT

Question 7

What is the therapeutic index for lithium?

Answer 7

• 0.4 - 1.0 mmol/L
• Long plasma half life
• Excreted primarily by kidneys
• Toxicity occurs >1.5 mmol/L

Question 8

What might lithium toxicity be precipitated by?

Answer 8

• Dehydration
• Renal failure
• Drugs → NSAIDs / Metronidazole / ACE-i / ARBs / Diuretics

Question 9

What are the clinical features of lithium toxicity?

Answer 9

• Vomiting and diarrhoea
• Ataxia / Dysarthria / Muscle twitching / Tremor
• Seizure
• Acute confusion

Question 10

How is lithium toxicity managed?

Answer 10

• Mild-moderate → volume resuscitation 0.9% Saline
• Severe → haemodialysis