What are the two main types of bipolar disorder diagnoses based on severity?
Bipolar I disorder (mania has occurred at least once) and bipolar II disorder (hypomania occurred, but not full mania) [1].
What is the estimated lifetime prevalence of bipolar disorder?
A relatively common disorder with a lifetime prevalence of 1-3%
What is the suicide risk associated with bipolar disorder?
The suicide risk is 10-15%
What are the main symptoms of mania?
Elevated mood, increased activity, self-important ideas, increased energy, restlessness, increased talkativeness, racing thoughts, reduced need for sleep, poor judgment, increased sexual desires, and possible psychotic symptoms like hallucinations and delusions
In which type of bipolar disorder is social capacity more preserved, and hospital admission not usually required?
Bipolar II disorder
What happens in mixed affective states?
Manic and depressive symptoms occur concurrently (e.g., people are overactive but experience depression)
What is the “monoamine theory” related to bipolar disorder aetiology?
The theory suggests a lack of monoamines (serotonin, noradrenaline, and dopamine) causes depression, and an excess causes mania
What evidence is there for a genetic influence in bipolar disorders?
Twin and adoption studies provide strong evidence; the lifetime prevalence of Bipolar I disorder increases from 0.5-1.5% to 4-9% in first-degree biological relatives
Which two neurotransmitters may also be involved in mood disorders?
Glutamate and gamma-aminobutyric acid (GABA
How does Lithium regulate multiple targets
It modifies the production and turnover of certain neurotransmitters (serotonin, acetylcholine, and GABA) and may inhibit secondary intra-cellular messenger systems (inositol monophosphatase, cAMP, and protein kinase C
What is the most likely mode of action for valproate?
Potentiation of the inhibitory action of GABA
How might carbamazepine produce an antimanic effect?
By reducing dopamine and noradrenaline turnover
What is the purpose of basis of the NICE guidelines to treat bipolar disorder?
They provide a basis for the management of bipolar disorder, generally considering management according to three phases: acute manic/hypomanic episode,
acute depressive episode, and prophylactic treatment
What is the first step in managing an acute manic episode with medication?
Stop any agent known to cause mania (e.g., corticosteroids, antidepressants, stimulants like caffeine, ginseng, amphetamines, and cocaine)
For the treatment of acute mania/hypomania in those not already on treatment, what does NICE recommend using?
Haloperidol, olanzapine, quetiapine, or risperidone
If the first antipsychotic is ineffective, what is the next step?
Adding lithium
If adding lithium is ineffective or not suitable, what should be considered next?
Adding valproate
What advice is given for those already on lithium or valproate treatment?
Optimise that treatment (check/increase serum lithium level if low; increase valproate dose to maximum tolerated level)
Is carbamazepine indicated in acute mania?
No, it is not indicated in acute mania
What are the different formulations of valproate, and which is chemically active?
Valproate semisodium and sodium valproate; both are metabolised to the chemically active valproic acid
Which specific valproate formulation is licensed in acute mania?
Valproate semisodium is licensed in acute mania
What is an important restriction to note regarding the use of valproate?
Restrictions apply to its use in people under the age of 55
What specific medications are mentioned as benzodiazepines that may be used in mood disorder management?
Diazepam, lorazepam, or clonazepam
What is the purpose of using benzodiazepines in this context?
To manage agitation and potentially avoid the need for high doses of antipsychotics
