Case Study 3- Bipolar Disorder

Question 1

What is the definition of bipolar disorder?

What are the two types of bipolar disorder?

Answer 1

Mental illness that causes unusual shifts in moods, energy, activity levels, concentration and the ability to carry out day to day tasks

Bipolar I- Mania

Bipolar II- Hypomania

Question 2

What are the symptoms of the manic phase of bipolar?

Answer 2

• Euphoria
• Talking quickly
• Full of energy
• Feeling self important
• Easily irritated or agitated
• Not feeling like sleeping
• Being delusional, having hallucinated or disturbed or illogical thinking

Question 3

What are the symptoms of the hypomanic phase of bipolar?

Answer 3

Symptoms are really similar to depression

• Loss of appetite
• Difficulty sleeping
• Waking up early
• Suicidal thoughts
• Sad, hopelessness or irritable
• Lack of energy

Question 4

True or false.
It is common for a person to experience symptoms of both depression and mania together

Answer 4

true
e.g. overactivity with a dperessed mood

Question 5

True or false?

It is common for a person with bipolar to readily swing from high to low phase quickly?

Answer 5

True

Question 6

For a person to be diagnosed with mania, how mon should manic symptoms last?

Answer 6

1 week

Question 7

True or false?

we no longer use antidepressants and antipsychotics to treat bipolar disorders

Answer 7

If there is co-existing depression then we would use antidepressants but should be avoided in patients with rapid cycling bipolar disorder

Question 8

What drugs are used to treat people with bipolar disorder?

Answer 8

• Atypical antipsychotic
• Valproate
• Lithium
• Adjunctive benzodiazepine

or combinations

Question 9

Benzodiazepines such as lorazepam can be used for the initial stage of treatment for behavioural disturbances or agitation. can these be used for a long period of time?

Answer 9

no, they have a risk of dependence

Question 10

What antipsychotics can be used to treat bipolar disorders?

Answer 10

• Risperidone
• Olanzapine
• Quetiapine

Question 11

How do 1st generation antipsychotics work? Give an example

Answer 11

• Inhibiting blocks dopaminergic neurotransmission
  in the brain
• (block dopamine in the brain)

Haloperidol

Question 12

How do 2nd generation antipsychotics work? Give an example.

Answer 12

• Inhibits dopaminergic neurotransmission as wells serotonin within the brain
• (blocks dopamine and serotonin in the brain)
• Risperidone

Question 13

What tests should be taken before starting a patient on 1st gen antipsychotics?

Answer 13

Electrolytes – correct any disturbances

Perform ECG before and during – QT interval prolongation risk !!!!

Question 14

What tests should be taken before starting a patient on 2st gen antipsychotics?

Answer 14

MONITOR PROLACTIN concentration at start of therapy, at 6 months and then annually (risperidone can cause hyperprolactinaemia – signs include breast enlargement)

Question 15

True or false,
Patients on 1st gen antipsychotics such as haloperidol can have an increase risk of extrapyramidal side effects?

Answer 15

True

Question 16

What are the signs and symptoms of extrapyramidal side effects ?

Answer 16

Akathisia (feeling restless)

Dystonia (involuntary muscle contraction)

Parkinsonism – symptoms of PD

Tardive dyskinesia (involuntary facial movements)

Question 17

What are the common side effects of 1st gen antipsychotics?

Answer 17

Common: depression, eye disorders, headache, nausea, weight loss

Question 18

What are the common side effects of 2st gen antipsychotics?

Answer 18

Common: anaemia, anxiety, chest discomfort, diarrhoea, fever, falls GI discomfort