PSYCHIATRY
BIPOLAR/MANIA
PromptClinical features of mania
ResponseGrandiosity/inflated self esteem
Pressured speech
Flight of ideas
Thought derailment/distractibility
Increased goal directed activity
Increased high risk activity - gambling/Spending money, Sexual promiscuity
Decreased sleep, increased energy
Past history of mania/bipolar
DIG FAST
Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity increase
Sleep decrease
Talkative
Pressured speech
Flight of ideas
Thought derailment/distractibility
Increased goal directed activity
Increased high risk activity - gambling/Spending money, Sexual promiscuity
Decreased sleep, increased energy
Past history of mania/bipolar
DIG FAST
Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity increase
Sleep decrease
Talkative
PromptNon psychiatric differentials of Mania
ResponseEndocrine - hyperthyroid, adrenal insufficiency, hyperparathyroid
Tox - Stimulant intoxication
Drug withdrawal
Encephalopathy
Seizure disorder
Acute intermittent porphyria
Tox - Stimulant intoxication
Drug withdrawal
Encephalopathy
Seizure disorder
Acute intermittent porphyria
PromptContrast Type 1 vs Type 2 Bipolar
ResponseBipolar 1
Mania (full blown) 1 episode longer than 1 week - energy, pressured speech, euphoria
Milder depression than type 2 (some no depression)
Bipolar 2
Hypomania >=4 days (Similar to mania but not less severe)
>=1 depressive episode broken up by periods of hypomania
Hopeless, fatigue, irritable and anxious
(Cyclothimia for bonus marks - hyponanic and depressive symptoms/episodes lasting >=2 years. Not severe enough to meet diagnostic criteria for 1 or 2)
Mania (full blown) 1 episode longer than 1 week - energy, pressured speech, euphoria
Milder depression than type 2 (some no depression)
Bipolar 2
Hypomania >=4 days (Similar to mania but not less severe)
>=1 depressive episode broken up by periods of hypomania
Hopeless, fatigue, irritable and anxious
(Cyclothimia for bonus marks - hyponanic and depressive symptoms/episodes lasting >=2 years. Not severe enough to meet diagnostic criteria for 1 or 2)
PromptInvestigations in mania
ResponseTFT - thyrotoxicosis
CTB - in first presentation of major mental health disorder
Serum sodium - excessive warter consumption, cause for delirium
LP - ?encephalitis, especially if febrile/meningism
BSL ? hypoglycaemia cause for delirium, hyperglycaemia with intercurrent illness if diabetic
Urine drug screen - ?amphetamine as precipitant for behavioral disturbance
CTB - in first presentation of major mental health disorder
Serum sodium - excessive warter consumption, cause for delirium
LP - ?encephalitis, especially if febrile/meningism
BSL ? hypoglycaemia cause for delirium, hyperglycaemia with intercurrent illness if diabetic
Urine drug screen - ?amphetamine as precipitant for behavioral disturbance