Bipolar Disoder

Question 1

What are the causes of drug induced mania?

Answer 1

The most common symptoms of drug-induced mania are: - increase activity - rapid speech - elevated mood - insomnia

Causes include:
- Hallucinogens (e.g LSD)
- CNS stimulants (e.g Amphetamines, caffeine)
- Antidepressants (switching from depression to mania)
- Antipsychotics

Bipolar episode triggers include:
- Life events such as e.g trauma, physical, sexual, or emotional abuse
- stopping a mood stabilised suddenly (esp lithium)
- potentially being on an antidepressant without a mood stabiliser in bipolar I
- Spring and summer
-Disrupted Circadian rhythms (e.g. shift-working)

Question 2

Non-Pharmacotherapy of bipolar

Answer 2

Psychological Therapies:
- psychological treatments such as psychotherapy, CBT and family therapy can be useful for some people. especially early on in the treatment when used with meds and perhaps in patients with difficult to treat symptoms
- Overall CBT does seem to help to stop the highs and lows in bipolar disorder
- Psychosocial interventions may have an important part to play. this reduces stress and helps manage symptoms.

Note: Mania is susceptible to stresses, e.g. changes in time zone, irregular sleep, substance misuse

Question 3

General prescribing rules for Mania:

Answer 3

• Discontinue any manicogenic agents, including antidepressants and stimulants.
• Stabilise any medical conditions.
  - Start non-specific calming meds. e.g. Benzo’s, Antipsychotics
• ONLY start specific mood-stabilisers or relapse prevention agents when the person is able to consent to longer-term therapy
• Hypnotic/sedative use should be considered appropriate as a nigh of sleep deprivation is likely to escalate any manic patients to a higher degree of mania
• Any co-morbid substance misuse must also be tackled, as recovery is poorer in people with people with a history of substance abuse.