Mania

Question 1

What are the features of mania?

Answer 1

Mnemonic: I DIG FASTER

Irritability

Distractibility/Disinhibited (sexual, financial)
Increased libido/ Insight impaired
Grandiose delusions

Flight of ideas
Activity/Appetite increased
Sleep decreased
Talkative (pressure of speech)
Elevated mood/Energy increased
Reduced concentration/Reckless

Question 2

What are some side effects of lithium??

Answer 2

Mnemonic: LITHIUM

Leukocytosis
Interstitial Nephritis
Tremor (Fine > Coarse)
Hydration decreased, polyuria
Increased GI, skin and memory problems
Underactive thyroid
Mum's beware (teratogenic)

Question 3

What is the treatment for acute mania assuming not on lithium?

Answer 3

Oral antipsychotic (1st line)
Try another antipsychotic (2nd line)
Add lithium/valproate (3rd line)

Question 4

What is the treatment for acute mania assuming he/she is on lithium?

Answer 4

Optimise dosage of lithium

Question 5

What is the treatment for bipolar depression?

Answer 5

High Intensity Psych Intervention (1st line)
Olanzapine +/- Fluoxetine OR Quetiapine alone (2nd line)
Lamotrigine (3rd line)

Question 5

What is the treatment for bipolar depression?

Answer 5

High Intensity Psych Intervention (1st line)
Olanzapine +/- Fluoxetine OR Quetiapine alone (2nd line)
Lamotrigine (3rd line)

Question 6

What is used for prophylaxis for bipolar affective disorder?

Answer 6

Lithium

Question 7

What investigations should be initiated before starting a patient on lithium?

Answer 7

Cardiac: ECG, BMI, weight

Renal: U + E

Thyroid: TFT

Question 8

3 complications of acute manic episode

Answer 8

STI
Loss of finances
Trauma/injury 
Damage to relationships with family members
Self-neglect