Mania, Schizophrenia, Bipolar

Question 1

What is mania?

Answer 1

An extreme mood state with irresponsible actions and grandiose views lasting at least one week to four months unless shortened by an intervention.

Question 2

What characterizes mania with psychosis?

Answer 2

Mania with features of psychosis, including hallucinations and delusions.

Question 3

Define hypomania.

Answer 3

A less severe episode of mania with minimal functional impairment, no hospitalization, and no psychosis.

Question 4

What does DIG-FAST stand for in the context of mania presentation?

Answer 4

• Distractability
• Irresponsible behavior
• Grandiosity with delusions
• Flight of Ideas
• Activity increases
• Sleep decreases
• Talkativeness

Question 5

What is the typical duration of a manic episode?

Answer 5

1-3 months.

Question 6

What is a mixed affective disorder?

Answer 6

Characterized by the presence of several prominent manic and several prominent depressive symptoms occurring simultaneously or rapidly alternating.

Question 7

What are the symptoms of bipolar disorder?

Answer 7

• Anhedonia
• Low mood
• Reduced interest/pleasure
• Reduced energy or fatigue
• Irresponsible behavior
• Grandiose views
• Overactivity and Flight of ideas

Question 8

List associated symptoms of bipolar disorder.

Answer 8

• Disrupted sleep
• Reduced concentration
• Low self-worth or excessive guilt
• Future hopelessness
• Recurrent thoughts of death
• Significant changes in appetite or weight
• Psychomotor agitation or retardation

Question 9

What are the ICD-11 classifications of mixed affective disorders?

Answer 9

• Bipolar type I
• Bipolar type II
• Rapid Cycling
• Cyclothymic disorder

Question 10

What defines Bipolar type I?

Answer 10

More than one manic or mixed episode with/without psychosis, and recurrent depressive and manic or mixed episodes.

Question 11

What defines Bipolar type II?

Answer 11

One or more hypomanic episodes and at least one depressive episode, with no history of manic/mixed episodes.

Question 12

What is rapid cycling in bipolar disorder?

Answer 12

> 4 mood swings within a year.

Question 13

What characterizes cyclothymic disorder?

Answer 13

Persistent affective disorder over ≥ 2 years with hypomania and depressive symptoms that are insufficient for a depressive episode diagnosis.

Question 14

What are some differential diagnoses for mixed affective disorders?

Answer 14

• Schizoaffective disorder
• Schizophrenia
• ADHD
• Drugs and Alcohol
• Stroke, Multiple Sclerosis, Tumour, Epilepsy
• AIDS, Neurosyphilis
• Endocrine disorders
• Systemic Lupus Erythematosus (SLE)

Question 15

What is the epidemiology of bipolar disorder?

Answer 15

Males = Females, positive family history, increased forms of depression.

Question 16

What are common investigations for mixed affective disorders?

Answer 16

• Social: collateral history and old notes
• Medical: U&Es, TFTs, Glucose

Question 17

Name tools used to measure symptoms of mixed affective disorders.

Answer 17

• SCID
• SCAN
• Young Mania Rating Scale (YMRS)

Question 18

What is the first-line treatment for an acute manic episode?

Answer 18

Atypical antipsychotic e.g. olanzapine, risperidone, quetiapine, clozapine.

Question 19

What should be monitored when using atypical antipsychotics?

Answer 19

Be aware of Agranulocytosis.

Question 20

What are second-line treatments for an acute manic episode?

Answer 20

• Mood Stabilizers e.g.
• Valproate
• Lamotrigine
• Lithium

Question 21

What is the gold standard treatment for mania?

Answer 21

Lithium.

Question 22

What are risks associated with lithium during pregnancy?

Answer 22

Risk of Ebstein’s anomaly.

Question 23

What is the treatment for depressive episodes in mixed affective disorders?

Answer 23

Atypical antipsychotic e.g. quetiapine, olanzapine; if ineffective, add anticonvulsant e.g. lamotrigine or lithium adjunct.

Question 24

What is the first-line maintenance treatment for bipolar disorder?

Answer 24

Lithium.

Question 25

What should be done if there are manic or depressive episodes during maintenance treatment?

Answer 25

First add an atypical antipsychotic, and if response is poor, consider anticonvulsants.

Question 26

What is the recommendation regarding antidepressants in bipolar disorder?

Answer 26

Avoid usage as they can cause rapid cycling mood and mania.