Bipolar / BPD

Question 1

Median age of manic episode onset and mean age of first hospitalization?

Answer 1

mid 20s first onset
26 years 1st hospitalization

Question 2

What usually preciptates 1st manic episode?

Answer 2

Life events e.g. bereavement, personal separation etc

Question 3

What drugs precipitate 1st manic episode?

Answer 3

Anti depressant monotherapy

Question 4

Risk factors for manic episode for depressive patients?

Answer 4

• Early age of onset
• Family hx of bipolar
• MDE in postnatal period
• Hypersomnia
• Psychotic symptoms

Ppl with these symptoms more likely to switch to mania from MDD

Question 5

Organic causes of mania?

Answer 5

Cerebrovascular accident
Right sided head injury
Endocrine - thyrotoxicosis, Cushings
Illegal drugs
Meds - steroids, levodopa/anticholinergics etc
Dementia/epilepsy/MS/Cerebral tumour etc

Question 6

Criteria for Bipolar 1 disorder?

Answer 6

Min 1 manic episode.
Dont need to be depressed. If have 1 manic episode = cfm have Bipolar 1

For episodes triggered by antiDEP use or electroconvulsive therapy, can still diagnose Bipolar 1 if symptoms persist after stopping treatment

Question 7

Criteria for Bipolar 2 disorder?

Answer 7

Past or current hypomanic episode, WITH current/past MDE.
+
Symptoms must affect functioning but not bad enough to cause marked impairment.

Cannot diagnose Bipolar 2 if there is previous manic episode.

Question 8

Mania vs Hypomania?

Answer 8

Mania = Min 1 week, function impaired, psychotic features
Hypomania = min 4 days, function not markedly impaired

Question 9

Invx for Mania?

Answer 9

1. FBC, ESR
2. LFT, RP, TFT, fasting lipids, glucose, body weight
3. VDRL (syphilis)
4. Urine drug screen
5. Pregnancy test
6. CT/MRI tro SOL, infarct
7. ECG tro prolonged QTc
8. EEG tro epilepsy

Question 11

What is mixed episode of Bipolar disorder?

Answer 11

Fulfils both manic and MDE symptoms for min 1 week

Question 12

What is rapid cycling disorder?

Answer 12

A part of course of bipolar disorder.
Min 4 episodes of mood disturbance in 1 year.

Frequency can be increased by antidepressant use

Commoner in women, occuring later in course of bipolar.

Question 13

Pharm mx of mixed state bipolar?

Answer 13

Mood stabilizers. Valproate and carbamazepine

Question 14

Maintenance mx for bipolar?

Answer 14

Lithium, valproate or olanzapine for maintenance therapy.
Aripiprazole for pts with recent manic or mixed episode.
Quetiapine + lithium/valproate for bipolar 1 disorder
If very severe, try lithium + valproate (complex decision)

Advised to continue mx for min 2years after episode of bipolar, up to 5 years if high risk of relapse

Question 15

How to manage pregnant bipolars?

Answer 15

Prefer typical antipsychotics e.g. chlorpromazine/haloperidol. Lower risk of metabolic ADRs
Consider electroconvulsive therapy.
Valproate / Carbamazepine preferred to lithium/lamotrigine during breastfeeding.