Week 8- Bipolar disorder

Question 1

what is bipolar?

Answer 1

-mood disorder
-Bipolar Disorder, has stages of mania/hypomania, depression and mixed episodes.
-It is a life-long with a high suicide rate (15-20%)
and co-morbidity
-some patients might self-medicate with alcohol and substances

Question 2

what are some co-morbidities related to bipolar?

Answer 2

• anxiety
• substance misuse
• personality disorder
• ADHD
• alcohol dependency
• eating disorder

Question 3

what is the epidemiology/incidence of bipolar?

Answer 3

• 1% of the Population diagnosed with Bipolar
• Up to 5% on the Bipolar spectrum
• The incidence is similar in both genders and all ages, races, ethnic groups and social classes
• Can occur at any age, although the first diagnosed episode is often between the ages of 18-24 years of age.
• There is increased general mortality regardless of age
• At least 70% people with bipolar disorder have at least one close relative with the illness or with unipolar depression

Question 4

what are some risk factors for getting bipolar?

Answer 4

Family history and genetics
Being male (only a very slight increase over women)

Question 5

what are some triggers for an episode?

Answer 5

-Life events such as e.g. trauma, physical, sexual, or emotional abuse
-Stopping a mood stabiliser suddenly, especially lithium
Potentially being on an antidepressant without a mood stabiliser if bipolar I
Having ECT for depression
Spring and summer
“Goal attainment events”
Disrupted Circadian rhythms e.g. shift-working

Question 6

what are the physical risks to individuals with bipolar?

Answer 6

• Obesity is more common
• Heart disease and high blood pressure X 5
• Poor Memory more likely
• Dying from a respiratory problem X3
• Dying from an infection is twice aslikely
• Life expectancy is about 10 years less due to substance misuse and delay in diagnosis

Question 7

what are the mental health to individuals with bipolar?

Answer 7

-Suicide X 14 greater risk
-Substance misuse is common
-1 in 2 dependent on alcohol and 2 in
5 may be dependent on other drug

Question 8

what are the social, relationship and work to individuals with bipolar?

Answer 8

-Symptoms can be highly damaging
to the person's social life, family
relationships and work.
-Poor work or school performanceFinancial problems from reckless
spending and being impulsive when high
-Violence to others when disturbed,
especially when high or low, or on
drugs/ alcohol
-Being promiscuous

Question 9

what should be offered to people to manage bipolar disorder in primary care?

Answer 9

• psychological intervention that has been developed specifically for bipolar disorder
• a high-intensity psychological intervention (CBT, IPT or behavioural couple’s therapy

Question 10

how should people with mania or hypomania manage in secondary care? pharmacological interventions

Answer 10

• If a person develops mania or hypomania and is not taking an antipsychotic or mood stabiliser, offer haloperidol, olanzapine, quetiapine or risperidone, taking into account any advance statements, the person’s preference and clinical context.
• If the person is already taking lithium, check plasma lithium levels to optimise treatment.
• Consider adding haloperidol, olanzapine, quetiapine or risperidone, depending on the person’s preference and previous response to treatment.

Question 11

how should people with bipolar depression in secondary care manage? psychological interventions

Answer 11

• psychological intervention that has been developed specifically for bipolar disorder
• a high-intensity psychological intervention (CBT, IPT or behavioural couple’s therapy
• Monitor mood for signs of mania or hypomania or deterioration of the depressive symptoms.

Question 12

how should people with bipolar depression in secondary care manage? pharmacological interventions

Answer 12

• Offer fluoxetine combined with olanzapine, or quetiapine on its own, depending on the person’s preference and previous response to treatment.
• If the person prefers, consider either olanzapine (without fluoxetine) or lamotrigine on its own.
• If there is no response to fluoxetine combined with olanzapine, or quetiapine, consider lamotrigine on its own.

Question 13

what is lamotrigine used for?

Answer 13

There is no evidence that lamotrigine is effective for acute bipolar depression, just for relapse prevention.

Question 14

what should be done to help adults manage bipolar long term in secondary care? pharmacological

Answer 14

• Offer lithium as a first-line, long-term pharmacological treatment for bipolar disorder and:
• If lithium is ineffective, consider adding valproate
• If lithium is poorly tolerated, or is not suitable (for example, because the person does not agree to routine blood monitoring), consider valproate or olanzapine instead or, if it has been effective during an episode of mania or bipolar depression, quetiapine.

Question 15

what should be done to help adults manage bipolar long term in secondary care? physical

Answer 15

Ensure that the physical health check for people with bipolar disorder, performed at least annually, includes:
• Weight or BMI, diet, nutritional status and level of physical activity cardiovascular status, including pulse and blood pressure metabolic status, including fasting blood glucose, glycosylated haemoglobin (HbA1c) and blood lipid profile
• Liver, renal and thyroid function
• Calcium levels, for people taking long-term lithium.
• Monitoring lithium