Mania and Bipolar

Question 1

What is mania

Answer 1

Pathological inappropriate elevated mood

Question 2

What are associated symptoms of mania

Answer 2

Grandiose ideas
Disinhibition
Loss of judgement
Similar to stimulant drugs - cocaine / AMPH

Question 3

How is hypomania classified by ICD-10

Answer 3

NO PSYCHOSIS 
Mild elevation of mood for several days 
<7-10 days 
No social or functional impairment 
Increased energy and activity
Increased socialibiltiy 
Over-familiar 
Increased sexual energy and libido 
Decreased need for sleep 
Decreased concentration 
Easily distracted
New interest
Mild overspending 
Can be irritable

Question 4

How is mania classified by ICD-10

Answer 4

1 week of elevated mode severe enough to disrupt work / social 
Increased energy and activity 
Pressure of speech 
Decreased need for sleep
Disinhibition
Grandiosity 
Senses intensified 
Extravagant spending
Reckless behaviour 
Irritable 
Flight of ideas - link 
With or without psychosis

Question 5

Ddx

Answer 5

Mixed affective state
Schizphrenia
Cyclothymia
ADHD
Drugs/ alcohol 
Stroke / MS / tumour / epilepsy
AIDs / neurosypihllis / SLE
Cushing's / hyperthyroid 
Steroid

Question 6

How is mania measured

Answer 6

SCID
SCAN
Young Mania Rating Scale

Question 7

How do you treat mania

Answer 7

Anti-psychotics for quick control
Mood stabilisers = 1st line
ECT
Short course of sedative in acute

Question 8

What are hallucinations in mania often

Answer 8

2nd person auditory

Question 9

What type of mood stabilisers are used

Answer 9

Lithium
Sodium valproate
Carbamazepine
Lamotrigene

Question 10

What is bipolar affective disorders

Answer 10

2+ episodes of depression + mania/ hypomania

Question 11

Are you more likely to have mania or bipolar

Answer 11

Bipolar
Mania on its own is very unlikely
More likely to have had an un Dx depressive episode

Question 12

How long does a typical episode last in bipolar

Answer 12

1-3 months

90% have further episodes

Question 13

What is the epidemiology of bipolar

Answer 13

M=F
Early onset if +ve FH 
Genetic
Brain structure 
Increased if 1st degree relative 
No relation to income / education / occupation 
Associated adverse childhood

Question 14

How do you treat bipolar

Answer 14

Mood stabilisers - lithium = 1st line
Don’t give anti-depressant alone as might go into manic episode which will make worse
Sometimes use if very resistant depression
Anti-psychotics
Sedative

Question 15

What do you do if bipolar presents in primary care

Answer 15

Refer

Question 16

If hypomania what do you do

Answer 16

Routine psych referral

Question 17

If mania or severe

Answer 17

Urgent psych referral

Question 18

What is type 1 bipolar

Answer 18

Mania and depression

Question 19

What is type 2

Answer 19

Hypomania and depression

Question 20

What do you use in chronic bipolar

Answer 20

Mood stabiliser

Anti-psychotic

Question 21

When do you use sodium valproate

Answer 21

If others tried

Question 22

What do you do if become manic

Answer 22

Stop anti-depressant
Anti-psychotic even if no psychosis
Benzo
Lithium

Question 23

What do you do if depressed

Answer 23

Therapy
SSRI
Never give SSRI as maintenance as risk of causing mania

Question 24

What do you give with SSRI

Answer 24

Anti-psychotic or mood as risk of manic

Question 25

What is important to address

Answer 25

CVS risk

Question 26

What suggest better prognosis

Answer 26

Duration / severity / frequency
Early Rx = better
No substance
No personality disorder

Question 27

What is cyclothymia

Answer 27

Rapid cycling but less extreme highs and lows
Hypomania and mild depression
Never asymptomatic for more than 2 months