Recurrent episodes of mania/hypomania and depression; bipolar I requires at least one manic episode.
Clinical features
- • Elevated or irritable mood
- • Reduced need for sleep
- • Grandiosity, pressured speech, flight of ideas
- • Risk-taking and overspending
- • Depressive episodes that predominate over time
Investigations
- • Collateral history
- • TFT, drug screen, CT head if first episode in later life
- • Lithium work-up: U&E, calcium, TFT, ECG, pregnancy test
Management
- • Acute mania: stop antidepressant; antipsychotic (olanzapine/quetiapine/risperidone)
- • Add lithium or valproate if inadequate response
- • Bipolar depression: quetiapine, olanzapine-fluoxetine or lamotrigine
- • Long-term: lithium first-line prophylaxis
- • Psychoeducation and relapse-prevention planning
Clinical pearls
- • Antidepressant monotherapy can precipitate mania or rapid cycling
- • Valproate is contraindicated in women of childbearing potential
Related in WardRound
Educational — verify locally.
