Bipolar disorder
Definition
Presenting Complaint: Brought in by police for asking women "if they wanted to sleep with me". Has felt that people should want to sleep with him for about a month, because he is amazing, and their personal saviour. No evidence of auditory or visual hallucinations
Past Psychiatric History: History of feeling very low. Last episode of low mood was about 6 months ago, when he saw his GP. Has attempted suicide once, a month ago, taking an overdose of pills, which he wished he hadn't recovered from.
Past Medical History: No relevant medical history.
Family History: Father had 'manic depression'.
Personal History: Never had any problems neonatally/early childhood. Enjoyed school, and had normal friendships. Got a degree in theoretical metaethics, and has since worked mostly in MacDonalds. Never had any long term relationships, but never had any unwanted sexual experiences.
Drug History: Took lithium a year ago, but stopped taking it 6 weeks ago. Doesn't drink, and doesn't abuse drugs.
Forensic History: Been in trouble with police just before current admission, and a year ago, when he was stopped in the town centre, approaching strangers and informing them that he was the Bangladeshan saviour of the world.
A mood disorder, characterised by one episode of abnormally elevated mood (known as mania).
In current thought, bipolar is a condition where the patient will experience periods at opposite ends of a mood spectrum: high and low. It is thought that depression is where the patient only experiences one end of the spectrum, hence depression being known as unipolar.
Epidemiology
Lifetime prevalence is around 0.8%.
Pathophysiology
There is a stronger genetic link in bipolar than in any other non-organic mental disorder. Aside from this, a stressful life event is often a precipitating factor.
Risk Factors
- Family History of Bipolar or Depression
- Past Medical history of depression.
Clinical Features
Investigations
Management
Short-term
To treat an acute episode of mania, use an antipsychotic first-line because they are awesome. If the patient has previously had a good response to lithium or valproate, feel free to use those too - "if it ain't broke, don't fix it", I guess. Benzodiazepines can also be used to sedate the patient if they're being fidgety.
If they're being really bad, you can tranquilise them using olanzapine, lorazepam or haloperidol im.
Long-term
Use olanzapine, lithium or valproate. (An atypical antipsychotic, mood stabiliser and anticonvulsant, respectively). Psychological therapy and education will help.