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| 2 weeks of Depressed mood + 5 or more of -Sleep disturbance -Interest Reduced -Guilt, worthlessness -Energy reduced -Concentration reduced -Appetite reduced -Psychomotor retardation/agitation -Suicidal ideation or attempts | ||
| -Increase in weight/appetite -Increased sleep -Leaden paralysis -Interpersonal rejection sensitivity -Mood reactivity | ||
| Bipolar I - Full manic/mixed episode, usually with major depressive episode Bipolar II - Major depressive episode + hypomanic episode Rapid cycling - 4 or more episodes in 12 months | ||
| 1 week of Increased mood + 4 or more of -Distractibility -Indiscretion -Grandiosity -Flight of ideas -Activity increased -Sleep decreased -Talkative | ||
| -Increased mood -Activity increased -Sleep decreased -Hedonic pursuits | ||
| 1. SSRIs (SEs anxiety, GI upset, headache, weight gain) 2. Anxiolysis with benzodiazepines (eg clonazepam) 3. SNRIs, NASSAs, TCAs, MAOIs ECT - for severe/drug-resistant depression, or depression in the elderly. | ||
| -CBT - correct negative perceptions, positive reinforcement -Psychoanalysis - insight-oriented -Supportive - emotional (for acute setting) -Group - support, interaction, self-correction and peer correction | ||
| Bloods: FBC, UEC, LFT, TFT, PRL, B12, Folate Cognitive: MMSE, executive functioning Psychological: rating scales (KIO, BDI, Zung, HAM-D), Rorschach, TAT | ||
| 1a. Mood stabilisers - lithium, valproate, carbemazepine 1b. Atypical antipsychotics - olanzapine, quetiapine, risperidone 2. Combination of mood stabiliser + atypical AP, or lithium + valproate 3. ECT 4. Clozapine (risk of pancytopaenia) | ||
| 1a. Lithium / quetiapine / lamotrigine monotherapy 1b. Lithium/valproate + SSRI or olanzapine + SSRI 1c. Lithium + valproate 2. Add mood stabiliser or SSRI 3. Mood stabiliser + SNRI/TCA/MAOI or ECT | ||
| -Social rehabilitation - regain social skills -Supportive -CBT - increase compliance, setting limits on impulsive behaviour, dealing with low mood -Family - education about illness, relapse recognition |
