Mood disorders

Question 1

what is bipolar disorder? what is the difference between type I and II?

Answer 1

Bipolar disorder = chronic mental health condition characterised by episodes of mania/hypomania and depression, separated by symptom free states.

Bipolar I = at least 1 manic episode +/- 1 or more depressive episodes
Bipolar II = at least 1 hypomanic episode + 1 or more depressive episodes

Question 2

what are the features of manic and hypomanic episodes? how are these different?

Answer 2

Features:

• elevated, expansive or irritable mood (only mildly in hypomanic)
• increased energy/activity
• increased self-esteem (may be grandiose delusions in severe mania)
• sociability, talkativeness, over-familiarity
• increased libido
• reduced need for sleep
• loss of concentration

Hypomania: no hallucinations or delusions and no significant effect in functional ability.

Mania: pressure of speech, flight of ideas, loss of social inhibitions (recklessness with money), psychotic symptoms.
In severe cases: lack of insight, auditory hallucinations and delusions of persecution in severe cases.

Question 3

how would you manage a patient with BD who presents acutely with mania?

Answer 3

1. consider hospital admission
2. if agitation: IM ARIPIPRAZOLE or IM OLANZAPINEif no agitation: PO LITHIUM +/- PO atypical antipsychotic e.g. OLANZAPINE, QUETIAPINE, ARIPIPRAZOLE

Question 4

how long should a BD patient being treated for acute mania continue medication?

Answer 4

Within 4 weeks of resolution of symptoms, discuss with the person whether to continue treatment for mania or start long‑term treatment (see section 1.7). Explain the potential benefits of long‑term treatment and the risks, including side effects of medication used for long‑term treatment.
If the person decides to continue treatment for mania, offer it for a further 3‑6 months, and then review.

Question 5

how would you manage a BD patient unresponsive to several lines of drug treatment?

Answer 5

consider ECT

Question 6

how would you manage a patient with bipolar depression in secondary care?

Answer 6

Bio

• offer lithium 1st line; if ineffective consider adding valproate
• consider valproate or olanzapine for patients intolerant of lithium (e.g. renal impairment) or who are not prepared to undergo regular monitoring
• if persistent symptoms, consider lamotrigine (esp. in BDII) or carbamazepine

Psycho

• offer family interventions to people living with, or in close contact with family
• offer structured psychological interventions (individual, family or group) which has been designed for BP