Week 2 - bipoar disorder

Question 1

What are the hall mark symptoms of mania ?

Answer 1

DIG FAST

Distractibility
Impulsivity/irresponsibility/irritability
Grandiosity

Flight of ideas
Activity increase
Sleep deficit (insomnia)
Talkativeness

Question 2

What is the difference between a manic and hypo manic episode ?

Answer 2

hypomania = less severe form of mania

hypomania - lasts at least 4 days
mania - lasts a week or more

• hypomania doesn’t involve psychotic features
• hypomania is not severe enough to cause marked social or occupational impairment

Question 3

What are the symptoms of delirium tremens (alcohol withdrawal delirium) ?

Answer 3

• signs of delirium
• autonomic system hyperactivity (sweating, tachycardia, fever…)
• insomnia
• anxiety
• hypertension
• visual or tactile hallucinations (insects crawling on skin etc)
• fluctuating motor activity (hyperexcitability to lethargy)

Question 4

What is the treatment for delirium tremens ?

Answer 4

benzodiazepines to reduce risk of seizure
- lorazepam
- diazepam
- chlordiazepoxide
- oxazepam

IV fluids for rehydration
pabrinex to reduce risk of wernickes encephalopathy

Question 5

What are the signs of wernickes encephalopathy?

Answer 5

• opthalmoparesis with nystagmus
• ataxia
• confusion

Question 6

What causes wernickes encephalopathy?

Answer 6

thiamine (B1) deficiency affecting peripheral and central NS

Question 7

What are the signs of korsakoff syndrome ?

Answer 7

• short term amnesia
• deficits in explicit memory
• confabulation (spontaneous or provoked)

Question 8

In an MSE, what is a common descriptor for how the patient in a manic episode speaks ..?

Answer 8

‘pressured speech’

Question 9

What would a typical MSE look like for someone presenting in a manic episode of bipolar disorder ?

Answer 9

A- agitated, irritable, restless, poor concentration, disinhibited

S - pressured speech

E - elevated

P - auditory hallucinations

T - flight of ideas, grandiose delusions

I - may have partial or poor insight

C - intact

Question 10

What are some physical health differentials to consider when suspecting bipolar disorder due to current mania ?

Answer 10

• stroke pathologies (frontal lobe damage)
• thyroid diseases
• cushings
• addisons
• illicit substance misuse

Question 11

what is the management for bipolar ?

Answer 11

• acute meds = antipsychotics for mania
• long term = mood stabilisers (lithium or sodium valproate)
• CBT
• financial aid

Question 12

What is Bipolar type 1 Vs type 2 ?

Answer 12

Type 1
- 2 or more episodes of mania lasting 1wk+
- with separate, distinct depressive episodes (potentially predating mania)

Type 2
- 2 or more episodes of hypomania lasting 4days+
- with separate, distinct depressive episodes (potentially predating mania)

Question 13

What are the ICD-10 criteria for dependence syndrome ?

Answer 13

3+ of the following at the same time during last year or constantly for a month …

a. strong desire or compulsion to take substance

b. difficulty controlling substance use (onset, termination, quantity)

c. evidence of tolerance (increased doses required to reach effects)

d. physiological withdrawal state when substance use is stopped or reduced

e. progressive neglect of other pleasures/interests due to use or time devoted to use, attainment or recovery.

f. persisting with substance use despite evidence of harmful consequences

Question 14

What are some mental health differentials for bipolar disorder ?

Answer 14

• personality disorders
• schizophrenia
• depression