Mania and Bipolar Flashcards
What is mania
Pathological inappropriate elevated mood
What are associated symptoms of mania
Grandiose ideas
Disinhibition
Loss of judgement
Similar to stimulant drugs - cocaine / AMPH
How is hypomania classified by ICD-10
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
How is mania classified by ICD-10
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
Ddx
Mixed affective state Schizphrenia Cyclothymia ADHD Drugs/ alcohol Stroke / MS / tumour / epilepsy AIDs / neurosypihllis / SLE Cushing's / hyperthyroid Steroid
How is mania measured
SCID
SCAN
Young Mania Rating Scale
How do you treat mania
Anti-psychotics for quick control
Mood stabilisers = 1st line
ECT
Short course of sedative in acute
What are hallucinations in mania often
2nd person auditory
What type of mood stabilisers are used
Lithium
Sodium valproate
Carbamazepine
Lamotrigene
What is bipolar affective disorders
2+ episodes of depression + mania/ hypomania
Are you more likely to have mania or bipolar
Bipolar
Mania on its own is very unlikely
More likely to have had an un Dx depressive episode
How long does a typical episode last in bipolar
1-3 months
90% have further episodes
What is the epidemiology of bipolar
M=F Early onset if +ve FH Genetic Brain structure Increased if 1st degree relative No relation to income / education / occupation Associated adverse childhood
How do you treat bipolar
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
What do you do if bipolar presents in primary care
Refer
If hypomania what do you do
Routine psych referral
If mania or severe
Urgent psych referral
What is type 1 bipolar
Mania and depression
What is type 2
Hypomania and depression
What do you use in chronic bipolar
Mood stabiliser
Anti-psychotic
When do you use sodium valproate
If others tried
What do you do if become manic
Stop anti-depressant
Anti-psychotic even if no psychosis
Benzo
Lithium
What do you do if depressed
Therapy
SSRI
Never give SSRI as maintenance as risk of causing mania
What do you give with SSRI
Anti-psychotic or mood as risk of manic
What is important to address
CVS risk
What suggest better prognosis
Duration / severity / frequency
Early Rx = better
No substance
No personality disorder
What is cyclothymia
Rapid cycling but less extreme highs and lows
Hypomania and mild depression
Never asymptomatic for more than 2 months
