Bipolar Disorder Flashcards
What are the signs of mania?
Mood: irritability, euphoria, lability
Cognition/thought: grandiosity, distractibility, flight of ideas, confusion, lack of insight
Rapid speech
Behaviour: hyperactivity, reduced sleep, hypersexuality, extravagance
Psychotic symptoms: delusions, hallucinations
Apart from positive signs, what other criteria need to be met for a diagnosis of mania?
Present for at least a week (can be shorter if intense enough to need admission)
Any impairment must be severe enough to limit function
What is hypomania?
Many of the characteristic symptoms of mania, but without the psychotic symptoms, impairment in daily functioning or need for inpatient treatment
What is bipolar affective disorder?
When mania alternates with depression
What is cyclothymia?
Cyclical mood swings with subclinical features
What are the potential causes of mania?
Medication: steroids, amphetamines, cocaine, antidepressants
Physical: infection, stroke, neoplasm, epilepsy, MS
Metabolic disturbance e.g. hyperthyroidism
What is done when assessing someone with mania?
Ask about infections, drug use, PMH/FH of psychiatric disorders
CT head, EEG, screen for drugs/toxins
Assess psychotic symptoms, cycling speed, suicide risk
How is acute mania treated?
Moderate/severe - any atypical antipsychotic or semisodium valproate
When is prophylaxis for bipolar disorder given and what is given?
Prophylaxis is given after the successful treatment of a manic/depressive episode for longer-term control
A mood stabiliser is given e.g. lithium carbonate
What monitoring needs to be done when prescribing lithium?
Pre-treatment U+Es, ECG and T4
Plasma lithium levels (0.6-1) - check weekly until stable or 4 weeks and then monthly for 6 months and then every 3 months if stable (check more often if on diuretics, NSAIDs, ACEi, low salt diet or pregnant)
U+Es and TSH 6 monthly
Why should you be extra careful when prescribing lithium in the elderly?
They are more sensitive to lithium neurotoxicity
What should you suspect if plasma lithium levels are rising progressively?
Progressive nephrotoxicity
What are the side effects of lithium?
Hypothyroidism
Nephrogenic diabetes insipidus
What are the signs of lithium toxicity?
Reduced vision Diarrhoea and vomiting Reduced potassium Ataxia Tremor Dysarthria Coma
What are the psychological interventions for bipolar disorder?
Psychoeducation, CBT and support groups
