Case: Mania and Bipolar

Question 1

Abnormally elevated or irritable mood

It is associated with:

Answer 1

• Increased energy & activity
• Increased talkativeness & sociability
• Inflated self-esteem & grandiosity
• Decreased need for sleep
• Poor concentration & distractibility
• Increased libido
• Overspending
• Reckless behaviour
• Racing thoughts

n a syndromal pattern

Question 2

Abnormally elevated or irritable mood

It is associated with:

• Increased energy & activity
• Increased talkativeness & sociability
• Inflated self-esteem & grandiosity
• Decreased need for sleep
• Poor concentration & distractibility
• Increased libido
• Overspending
• Reckless behaviour
• Racing thoughts

in a syndromal pattern

Which psychotic symptoms can it involve?

Answer 2

Can include psychotic symptoms

• Speech can show flight of ideas
  
  • thoughts jumping from topic-to-topic
• Delusions
  
  • usually grandiose e.g. “I am king of Scotland”, “I can control the weather”
• Hallucinations
  
  • usually 2nd person auditory

Question 3

What are the treatments for mania?

Answer 3

1) Benzodiazepines/sedation
* calm patient down and re-instate normal sleep pattern
2) Antipsychotics
* have sedative and mood-stabilizing properties, as well as reducing any psychotic symptoms
3) Consider stopping any antidepressants
* these can induce or worsen mania
4) Mood stabilisers
* Lithium, anticonvulsants

Question 4

What is bipolar affective disorder?

Answer 4

This disorder is characterised by repeated episodes of mania and depression:

• at least two episodes of mania
• (or) one episode of mania and one episode of depression

Characteristically, recovery is usually complete between episodes

Patients who suffer only from repeated episodes of mania are rare, and they are classified as having bipolar disorder

Question 5

What are the treatments for bipolar disorder?

Answer 5

Mood stabilisers

• lithium and anticonvulsants

Antipsychotics

• even if not psychotic

Antidepressants may be appropriate

• so long as they have not induced mania for the patient in the past!

Often multiple medications are used

Question 6

What are some symptoms of mania?

Answer 6

• Elevated mood
• Increased energy
• Poor sleep
• Increased libido
• Overspending
• Relationship difficulties
• No longer working

Question 7

What features might a person with mania display on a mental state examination?

Answer 7

• Mildly unkempt
• Quite animated, increased range of expression
• Elated and can be irritable
• Over talkative
• Over familiar at times
• Evidence of grandiose thinking
• Poor insight