bipolar affective disorder

Question 1

how long do you have to have an elevated mod for to have mania?

what symptoms are they likely to have?

Answer 1

• at least 1 week
• irritability
• pressure of speech (increased talkativeness)
• flight of ideas
• loss of social inhibitions
• insomnia/ reduced need for sleep
• inflated self esteem/ grandiosity
• distractibility
• reckless or foolish behaviour
• raised libido

Question 2

what is the difference between mania and hypomania?

Answer 2

• persons mood elevated, with same symptoms as mania
• has to last at least 4 days
• but it does not significantly affect AODL
• no psychotic episodes

Question 3

what baseline investigations should you do before starting lithium?

Answer 3

• pregnancy test
• Thyroid and kidney function
• ECG
• FBC

Question 4

when should you test lithium levels?

Answer 4

• 12 hours after last dose

Question 5

what are the side effects of lithium?

Answer 5

• diabetes insipidus
• hypothyroidism
• kidney failure
• weight gain
• fine tremor
• polyuria/ polydipsia
• GI upset

Question 6

what are the risk factors for lithium toxicity?

what is normal range for lithium?

Answer 6

• Drugs (NSAIDs, diuretics)
• UTI
• dehydration
• renal failure
• 0.4-1

Question 7

what are early symptoms of lithium toxicity?

the late ones?

Answer 7

• blurred vision, anorexia, n+v, diarrhoea, coarse tremor, ataxia, dysarthria
• confusion, renal failure, delirium, fits, coma, death

Question 8

what is the treatment for lithium toxicity?

Answer 8

• give fluids and start diuresis/ dialysis

Question 9

what should everyone be asked who comes in with a history of depression?

Answer 9

• whether they have had any previous feelings of disinhibition or irritability

Question 10

what non pharmacological treatment should be offered to people with bipolar depression?

pharmacological?

Answer 10

• high intensity psychological intervention

- check lithium levels, consider adding mood stabilisers, APs and antidepressants e.g. fluoxetine and quetiapine

Question 11

if a patient develops mania with a previous history of depression what would you enquire about?

what is the first line treatment for mania if not already on mood stabiliser or AP?

2nd and 3rd line?

Answer 11

• whether they are on SSRI, possibly causing manic symptoms (take them off SSRI)
• antipsychotics: haloperidol, olanzapine, quetiapine, risperidone
• lithium
• sodium valproate

Question 12

before starting someone on an AP what baseline investigations must you check?

Answer 12

• weight or BMI (weight gain)
• HbA1c (reduced glucose tolerance)
• blood lipid profile (increased risk of stroke)
• blood pressure (antiadrenergic)

Question 13

what should be monitored whilst taking APs and how often?

how long should antipsychotics be stopped over?

Answer 13

• weight (weekly for 1st 6 weeks then at 12 weeks)
• emergence of movement disorders
• pulse and BP after each dose change
• 4 weeks

Question 14

what do you need to monitor when starting valproate?

who should not be offered valproate at all?

Answer 14

• FBC and LFTs
• stop immediately if abnormal liver function or blood dyscrasia detected
• women of child bearing age