Mania
Clinical features
- Abnormally elevated mood, agitation or irritability
- Hyperactivity, restlessness
- Speech - pressured, flight of ideas
- Disinhibition and increased libido
- Impulsive behaviours - gambling, spending sprees etc.
- There may be a history of psychotic symptoms - grandiose delusions, or auditory hallucinations
- Symptoms persist for at least 7 days for a formal diagnosis, and result in significant functional impairment
Hypomania
- Similar features to mania - but to a less severe extent, with less of a functional impairment (e.g. socially or at work).
- Psychotic features are NOT present
- Symptoms include a mild elevation of mood, irritability, hyperactivity, over-familiarity and talkativeness.
Mixed episode
- Suggested by rapidly alternating symptoms of depression and the above features of mania or hypomania.
Bipolar affective disorder (BAD)
Bipolar affective disorder is a chronic mental health condition which is characterised by episodes of depression and hypomania or mania.
The DSM-5 diagnostic criteria defines BAD as follows:
- Type 1 BAD: At least one episode of mania with or without a history of depressive episodes
- Type 2 BAD: One or more depressive episodes and at least one hypomanic episode (without mania)
Management of Mania / BAD
Treatment of acute mania or mixed episodes
Step 1: Oral antipsychotic (haloperidol, quetiapine, risperidone or olanzapine)
Step 2: If not effective or not tolerated, try an alternative antipsychotic from above
Step 3: If not effective, add lithium (or sodium valproate as an alternative)
Other: Stop or taper dose the dose of antidepressant medications
Treatment of depression
Options include:
- Quetiapine
- Lamotrigine
- Olanzapine
- Olanzapine and fluoxetine
Long-Term Management of BAD
Four weeks following acute episode, either:
- Continue the antipsychotic/ current treatment for mania
- Or commence long term lithium to prevent relapse (and add valproate if req.)
In addition, offer psychotherapy to all patients with BAD, or a high-intensity therapy for depression (e.g. CBT).
References and Further Reading