Bipolar disorder and mania

Question 1

Bipolar disorder - chronic

Answer 1

Lows and highs (hypomania/mania)

Question 2

Symptoms of mania (3 or 4)

- hypomania - less severe

Answer 2

1. Less sleep, increased energy
2. Talkative
3. Irritated
4. Spent of a lot of money, alcoholic
5. Self importance

Question 3

Symptoms of depression

Answer 3

1. Low mood
2. Loss of enjoyment
3. Feeling guilty
4. Poor motivation
5. Sleeping problems, poor concentration

Question 4

Treatment (1)

Answer 4

At least 2 years treatment from last manic episode to 5 years if there is high risk of relapse

Question 5

Treatment (2)

Answer 5

Anti-depressant for depression - avoid in patients with rapid cycling bipolar
BZ for agitation - avoid LT

Question 6

Treatment (3)

Answer 6

AP - quet, olan/risp for mania for hypomania - lithium or valproate can be added

Question 7

Treatment (4)

Answer 7

Carbamaz - rapid cycling/prophylaxis

Question 8

Treatment (5)

Answer 8

Lithium - prophylaxis and treatment for mania, hypomania and depression - treat self harming behaviour
- effect becomes apparent 6-12 months after starting

Question 9

Lithium C/I:

Answer 9

Inadequate sodium diet*
Addison’s disease
Dehydration*
Untreated hypothyroidism

Question 10

Lithium cautions:

Answer 10

1. Avoid abrupt withdrawal
2. Diuretic treatment (increase risk of toxicity) - low Na+
3. QT prolongation
4. Review dose in elderly, vomit/surgery/diarrhoea - lose electrolytes - toxicity*
5. LT monitor 6 monthly - thyroid disorder hypo

Question 11

Side effects:

Answer 11

1. Tremor
2. Arrhythmias
3. Memory loss
4. Hypothyroidism
5. Angioedema

Question 12

OD:

Answer 12

Polyuria, fine tremor, seizures, coma, confusion, visual disturbances, n+v

Question 13

Preg/BF

Answer 13

Avoid - esp 1st trimester, dosing requirements may increase during 2nd/3rd

Question 14

Monitor

Answer 14

0. 4-1mmol/l - elderly, maintenance dose
1. 8-1mmol/l - acute episodes mania/relapsed

3 monthly - lithium
Cardiac, thyroid, renal function, BMI, FBC and electrolytes

Question 15

Withdrawal:

Answer 15

Do not stop abruptly - risk of relapse
Withdraw over 4 weeks to 3months
Change to AP or valp if need to stop urgently

Question 16

Patient and carer advice

Answer 16

Benign intracranial BP - persistent headache/visual
Lithium card
Hypothyroidism
Renal dysfun e.g polydip
Maintain adequate fluid intake

Question 17

Drugs which increase the conc of lithium

Answer 17

1. NSAIDS
2. ACEi/ARBs
3. Diuretics (thiazide/loop)
4. Carbma (neurotoxic)