Mania, hypomania + bipolar

Question 1

difference between hypomania and mania

Answer 1

hypo - 4+ days

hyper - 7+ days + grandiose delusions, hallucinations

Question 2

symptoms of hypo/mania

Answer 2

euphoric
energetic
racing thoughts
full of ideas
irritable
restless
confident
sexual desire
risky behaviour
talkative
bright clothing

Question 3

types of bipolar

Answer 3

1 - mania + depression

2 - hypomania + depression

Question 4

differentials for bipolar

Answer 4

schizophrenia
schizoaffective
drug-induced psychosis
hyperthyroidism

Question 5

differentiating bipolar mania with psychosis from schizoaffective

Answer 5

bipolar - mood high then psychosis follows

schizoaffective - psychosis then high mood follows

Question 6

bipolar history - symptom to ask about

Answer 6

special powers

Question 7

management of bipolar: 1st-4th line + in most severe cases?

Answer 7

1° - atypical antipsychotic + CBT when stable (focused on symptoms)
2° - alternative antipsychotic
3° - lithium (branded)
4° - valproate
severe - 6-12 sessions ECT

address comorbidities - 3x risk DM, HF, COPD

Question 8

management of acute episode of bipolar (mania, hypomania or severe depression)

Answer 8

mania:
urgent referral to CMHT
?stopping antidepressant
antipsychotic - olanzapine or haloperidol 
± short term benzo

hypomania:
routine referral to CMHT

severe depression:
urgent referral to CMHT

Question 9

lithium - complications

Answer 9

toxicity - narrow therapeutic range

nephrotoxicity - hydration a factor
diabetes inspidus

hypothyroidism
hypercalcaemia

Question 10

lithium - monitoring

Answer 10

lithium levels - weekly for 1mo, then 3mo for first year, then 6mo

baseline + every 6mo
ECG + BMI
FBC, renal + liver function
TFT + bone profile - hypothyroidism, hypercalcaemia

Question 11

lithium - interactions

Answer 11

NSAIDs
diuretics
ACEis

maybe cos nephrotoxic?

Question 12

lithium - SEs

Answer 12

fine tremor
Metallic taste
Oedema
Spots
Thirst + polyuria
GI (pain + nausea)

fine - MOST GI

Question 13

lithium - signs of toxicity

Answer 13

D+V
coarse tremor + muscle twitching (ie sped up)
Loss of coordination, slurred speech + drowsiness (ie slowed down)

Question 14

valproate - complications? + extra for semisodium?

Answer 14

hepatotoxicity
teratogenicity (NTDs)
semisodium valproate - hair loss

Question 15

which antipsychotic can be used in pregnancy?

Answer 15

olanzapine

Question 16

lithium - when + how to take? how long for? how long till effects?

Answer 16

1-2x per day - depends on brand
oral - tablet, capsule or syrup
1-2 weeks until effects
lifelong - regular psych reviews

Question 17

lithium - contraindications

Answer 17

1st trim pregnancy + breast feeding

cardiac + renal disease

Question 18

lithium - lifestyle

Answer 18

eat adequate salt

Question 19

side effects of ECT

Answer 19

short term memory loss
headaches
muscle aching

Question 20

management of depression in bipolar

Answer 20

fluoxetine