Bipolar Disorder

BPD: What is it?

BPD type 1→ 1+ manic episodes and 1+ depressive episodes

BPD type 2→ recurrent major depressive episodes and hypomanic episodes

BPD: What is the difference between mania and hypomania?

• Mania→ severe increased or decreased function for at least 7 days with psychotic symptoms

• Hypomania→ increased or decreased function for at least 4 days without psychotic symptoms

BPD: What are the signs of mania?

• Elevated or irritable mood

• Extreme self-esteem

• Low need for sleep/sleep disturbance

• High energy levels

• Very chatty

• Impulsive behaviour e.g. gambling, sex, addiction

BPD: What is the management of hypomania?

Routine referral to community mental health team

BPD: What is the management of mania?

Urgent referral to community mental health team

BPD: What is the management of acute mania?

• Mania with agitation→ IM neuroleptic (e.g. olanzopine) or benzodiazepine

• Mania without agitation→ oral quetiapine (or haloperidol, olanzapine, risperidone)

BPD: What is the maintenance therapy of chronic mania?

4 weeks after an acute episode start:

• 1. Lithium (first line)

• 2. Valproate (second line)

BPD: What is the complication of lithium therapy?

Nephrogenic diabetes insipidus→ now referred to as arginine vasopressin resistance (AVP-R).→ presents as extreme thirst and weight loss

BPD: What are the side effects of sodium valproate?

The main side effects of valproate can be remembered with the mnemonic "VALPROATE".

• Vomiting

• Alopecia

• Liver toxicity

• Pancreatitis/Pancytopenia

• Retention of fats (ie. weight gain)

• Oedema

• Anorexia

• Tremor

• Enzyme inhibition