Bipolar affective disorder

Case 1

1. A patient presents with history of;
1. Appeareance:
2. Not sleeping for 3 days, still he appears fresh
3. Talking continously
4. Says he is one of the richest person of Nepal
5. Appears restless
6. When opposed appears irritable and violent

What is a manic episode?

1.An acute episode with symptoms lasting for at least 1 week

a.     Extremes of mood

b.     Excessive energy, activity and talking

c.     Recklessness

2.Other features:

a.     Drastic, sudden change from normal state

b.     Person loses control of his her life (e.g. spending too much money, promiscuity etc)

c.     Severe impairment of daily function – person often ends up in hospital or jail

What is Bipolar Affective Disorder ?

A state where there is at least one episode of mania or hypomania with one episode of depression.

Why do we need to know about BPAD

1. Severely incapacitating disorder
2. May cause harm to self and others
3. Can be treated by Primary health worker
4. High Suicide rate

Treatment

1. Requires regular monitoring and treatment.
2. Awareness about symptoms
3. Olanzapine and Carbamazepine

Olanzapine

1. MOA
2. T1/2 : 21 to 54hrs
3. Metabolism
4. Elimination

Olanzapine dosing

Start with 5 mg

Increase 5mg every 5 days until symptoms improve

Minimum effective dose : 10mg

Maximum dose : 20mg

¨  Side effects

a.      Common side effects of Olanzapine : drowsiness, weight gain

b.     Less common side effects of Olanzapine :constipation, dry mouth , peripheral oedema, postural hypertension

Lithium

1. MOA:
2. Dosing:
1. 900–1200 mg/day in divided doses (maintenance)
3. S/E:
1. Ataxia, dysarthria, delirium, tremor,memory problems
2.  Polyuria, polydipsia (nephrogenic diabetes insipidus)
3. Diarrhea, nausea
4.  Weight gain
5. • Euthyroid goiter or hypothyroid goiter, possibly with increased TSH and reducedthyroxine levels

•         Acne, rash, alopecia

6.  Leukocytosis