Mania/Bipolar Affective Disorder

Question 1

What are the clinical features of mania?

Answer 1

Irritability
Grandiose ideas and inflate self-esteem
Increased energy and activity
Flight of ideas
Rapid, pressure speech (may be unintelligible)
Enhanced libido often leading to disinhibition and inappropriate sexual activity
Impaired judgement and impulsive behaviour including gross over-spending/poor decision-making ability
Decreased need for sleep
Increased sociability
Impaired concentration and attention
Psychotic symptoms (psychosis is lack of reality)

Question 2

What is the difference between manic mania and hypomania?

Answer 2

ania is an elated mood lasting 1-2 weeks or more with psychotic symptoms, and hypomania is an elated mood with no psychotic features lasting at least >4 days.
- hypomania is the functional form and often doesn’t require a hospital admission

Question 3

What are the consequences of mania?

Answer 3

Mania can lead to more consequences than a low mood. This can include disruption in social and occupational functioning, poor insight (classic of mania), risk of serious financial, legal or physical harm and so usually requires hospitalisation. Patients are at risk of ruining their reputation with inappropriate/bizarre behaviour.

Question 4

What is incongruence in terms of mania symptoms?

Answer 4

Incongruence is when their affect doesn’t match with what they are saying e.g. laughing/smiling when talking about death in the family or suicidal ideation.

Question 5

What are the differential diagnoses for mania?

Answer 5

Organic mood disorders (organic mania, bipolar or mixed affective disorder)
Psychoactive substance abuse 
- Intoxicated or psychotic disorder 
Schizoaffective disorder 
Manic episode 
Bipolar affective disorder 
Cyclothymia

Question 6

Treatments for mania (general)?

Answer 6

These can be biological, psychological or social. Biological therapies include antidepressants, antipsychotics, ECT and mood stabilisers (to prevent BPAD fluctuations). Psychological therapies include CBT, psychodynamic therapy, family therapy and counselling. Social support comes in the form of help with debt/housing issues and increased socialisation.

Question 7

What is bipolar affective disorder

Answer 7

Formally known as manic depression, bipolar disorder is a condition where your moods can swing rapidly from one extreme (depression) to another (mania).

Question 8

Aetiology of bipolar affective disorder.

Answer 8

It has a prevalence of 1-1.5% and is more common in women. Onset is typically during the teenage years, and if the first incident is after the age of 45, an organic cause should be considered. There is an increased risk if there is a family member with depression or bipolar

Question 9

Clinical features of bipolar affective disorder?

Answer 9

The clinical features are that of mania (see above) during the manic episodes and of depression during the depressive episodes

Question 10

How is bipolar affective disorder diagnosed?

Answer 10

Must be a history of at least one depressive and one mania/hypomania episode

Question 11

How is an acute manic episode treated in BPAD?

Answer 11

First line
- Atypical antipsychotic
Second line
- Valproate, lamotrigine or lithium

Question 12

How is a depressive episode treated in BPAD?

Answer 12

AVOID ANTIDEPRESSANTS – cause rapid cycling mood
- In some cases an SSRI may be suitable, but you need to be careful
Clozapine (atypical antipsychotic)
Consider atypical antipsychotics, anticonvulsants or a possible lithium adjunct

Question 13

What drug is used for general maintenance in bipolar affective disorder?

Answer 13

Lithium - mood stabiliser