Bipolar disorders

Question 1

What is the condition called with chronic mood swings between mild depression and mild hypomania (not severe enough to meet bipolar criteria)

Answer 1

Cyclothymia

Question 2

For cyclothymia to be diagnosed, how long do symptom-free periods last?

Answer 2

No longer than 2 months

Question 3

Which type of bipolar has episodes of mania?

Answer 3

Bipolar I
(Bipolar II has episodes of hypomania)

Question 4

True or false - for a diagnosis of Bipolar I, an individual must have experienced a major depressive episode

Answer 4

False
It is common but not necessary. It is necessary for Bipolar II

Question 5

How many episodes of mania are needed to diagnose Bipolar I?

Answer 5

Only one that lasts at least 1 week or less if hospitalised.

Question 6

What is required for a diagnosis of Bipolar II?

Answer 6

One hypomanic episode (at least 4 days) and at least one major depressive episode. Never had full mania.

Question 7

How long does mania last?

Answer 7

At least 7 days

Question 8

When do you hospitalise an individual having mania?

Answer 8

If they are a harm to themselves or others

Question 9

What differentiates hypomania from mania?

Answer 9

In hypomania there is no self-neglect but there is in mania. In hypomania, social life, commitments and finances are only mildly affected.

Question 10

What is first line management for acute mania?

Answer 10

Stop SSRIs
Start antipsychotic or benzodiazepine

Question 11

What is first line management for acute depressive episode?

Answer 11

SSRI (fluoxetine) and antipsychotic

Question 12

What is the gold standard long term management of bipolar disorder?

Answer 12

lithium

Question 13

What is the second line long term management of bipolar?

Answer 13

Anti-epileptics
eg. valproate, lamotrigine, carbamazepine