Bipolar Disorder: A Quick Recap

The mnemonic DIG FAST helps to outline the clinical presentation seen in mania (mood of an abnormally elevated arousal of energy level)

  • Distractibility
  • Insomnia
  • Grandiosity
  • Flight of ideas
  • Activities / psychomotor Agitation
  • Sexual indescretions
  • Talkative / pressured speech

Depressed Brain

While interviewing the patient suspected of having bipolar disorder it is helpful to pay attention to these signs – patients may report excessive engagement in pleasurable activities (excessive spending, sexual activity etc…)

This elated mood however may change to a low mood associated with low self esteem or even depression, and a restricted emotional expression… these patients who suffer from bipolar disorder are sometimes distrustful and suspicious — and occasionally interpret others’ motives as malevolent.

These patients who suffer from bipolar disorder are often involved in reckless behaviors (irrational anger, fighting, shouting, bragging, drug abuse marijuana, alcohol etc…)

These patients have ideas of grandiosity (an unrealistic sense of superiority), they may believe they have the next great invention or product in hand and spend many sleepless nights reading/studying watching T.V preparing for there “breakthrough”.  These patients are also highly distracted going from one topic to another  and when they speak their speech is pressured and often loud.

Treatment:

Mood stabilizers are needed for maintenance therapy

Lithium (first line treatment) watch out for narrow therapeutic window [ Lithium toxicity > 1.5 mEq/L] note ataxia, dysarthria, delirium, and acute renal failure — this is why we usually avoid Lithium in patients with poor renal function.

Carbamazepine is our (second line treatment) watch out for side effects such as nausea, skin rash (SJS), leukopenia…

Valproic acid and Lamotrigine can also be used

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