Mania and Hypomania

Question 1

how long should long-term treatment of bipolar disorder continue for?

Answer 1

1) At least two years from the last manic episode

2) Up to five years if the patient has risk factors for relapse

Question 2

An antidepressant drug may be required for the treatment of co-existing depression in those with mania and hypomania. But should these be avoided in? (3)

Answer 2

1) Rapid-cycling bipolar disorder
2) Recent history of hypomania
3) Rapid mood fluctuations

Question 3

When are benzodiazepines e.g. lorazepam used in the treatment of mania and hypomania?

Answer 3

1) Helpful in the initial stages of treatment for behavioural disturbance or agitation
2) Not to be used for long term due to risk of dependence

Question 4

List 3 antipsychotic drugs normally used in the management of mania

Answer 4

1) Olanzapine
2) Quetiapine
3) Risperidone

Question 5

1) when are antipsychotic drugs used in the management of mania?
2) which drugs can be added to treatment if the response to antipsychotic drugs is inadequate? (2)

Answer 5

1) Useful in acute episodes of mania and hypomania
2) lithium or valproate- antipsychotic drug may be used with lithium or valproate in the initial treatment of severe acute mania.

Question 6

which antipsychotic drug can be used for the long-term management of bipolar disorder?

Answer 6

1) Olanzapine:in patients whose manic episode responded to olanzapine therapy
↳(Asenapine, 2nd gen, is licensed moderate to severe manic episodes associated with bipolar disorder)

Question 7

Explain how antipsychotics should be discontinued including the withdrawal periods

Answer 7

1) Dose reduced gradually over 4 weeks if the patient is continuing with other antimanic drugs
2) if not continuing with other antimanic drugs or history of manic relapse, consider withdrawal period of up to 3 months

Question 8

When is carbamazepine indicated for use in this condition? (specialist)

Answer 8

prophylaxis of bipolar disorder (manic-depressive disorder) in patients unresponsive to a combination of other prophylactic drugs; used in patients with rapid-cycling manic-depressive illness

Question 9

when is valporate used in the management of bipolar disorder? (specialist)

Answer 9

1) For the treatment of manic episodes

2) Used for the prophylaxis of bipolar disorder

Question 10

In patients already taking valporate, but experiencing frequent relapse or continuing functional impairment what treatment options can be considered?

Answer 10

1) Consider switching to lithium or olanzapine

2) or adding lithium or olanzapine to valproate

Question 11

Outline when lithium is used in the management of bipolar disorder (specialist)

Answer 11

1) Prophylaxis and treatment of mania, hypomania and depression in bipolar disorder (manic-depressive disorder
2) prophylaxis and treatment of recurrent unipolar depression
3) Can be added on to treatment with antidepressants.

Question 12

Mania and hypomania can be experienced as part of a mood disorder such as bipolar disorder. what is the difference between mania and hypomania?

Answer 12

1) Hypomania is a milder version of mania that lasts for a short period (a few days)
2) Mania is a more severe form that lasts for a longer period (a week or more)
↳(Some people find these enjoyable, whereas for other people it is a very uncomfortable and distressing )

Question 13

how long can it take for the full prophylactic effect of lithium to occur?

Answer 13

May not occur for 6 to 12 months after the initiation of therapy