Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Bipolar affective disorder

Clinical Discipline(s)/Organ System(s)
Psychiatry/Health Psychology
Progress Test Topic(s)
Mental health
You are on call with the psychiatric registrar who is contacted by the Emergency Department to review a 19 year old, single NZ European man who works as an apprentice panel beater. He arrives accompanied by three 'mates' who describe him as a 'bit mental' and 'over the top'. He is half-shaved but casually attired; and he is easy to engage. He denies being ill but describes how he is going to find a niche in motor vehicle engineering that would revolutionise the car industry. He describes sitting up late at night with 'thousands of ideas', capturing these in a journal. Consequently, he only sleeps 3-4 hours per night and claims that he doesn't need more than this. His appetite has been poor but he reasons that this was because he was 'on a roll'. Friends describe him as more than usually talkative, loud, restless and irrational at times and say that he becomes irritable when this is pointed out, accusing his friends of turning on him as they are jealous of his pending fortunes.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Biopsychosocial theories of the aetiology of bipolar affective disorder
   - DSM-IV diagnostic criteria for bipolar affective disorder and other relevant psychiatric disease
   - Medications for bipolar disorder and their associated pharmacology and monitoring requirements e.g. lithium, sodium valproate, lamotrigine, carbamazepine and antipsychotics
   - Use of antipsychotics, antidepressants, and hypnosedatives
Clinical and Communication Skills 
   - Elicit a comprehensive psychiatric and medical history from a patient with bipolar affective disorder
   - Perform a mental state examination of a patient with bipolar affective disorder; recognise the typical findings in a patient with mania
   - Perform a risk assessment for harm to self or others; assess suicide and neglect risk
   - Differential diagnosis of mania, including rapid cycling
   - Awareness of association with post-partum psychosis and consideration of risks of treatment during pregnancy vs. teratogenicity
   - Role of substance abuse, particularly alcohol
   - Interpret relevant investigations: electrolytes, hormonal screening, toxicology screen
   - Management of mania and bipolar affective disorder: pharmacological, psychological, and other non-biological methods
   - Role of early intervention services, crisis care services and the community mental health teams
   - Prognosis of bipolar affective disorder
Personal and Professional Skills 
   - Best interests principle
   - Social impact of mental illness
   - Communicating the diagnosis of a mental illness to a patient and their family/whānau
   - Mental Health Act application and criteria for compulsory admission
   - Principles underlying competency and criteria to define someone as 'not competent'
   - Non-judgemental, empathic approach to mental illness
   - Recovery principles
Hauora Māori 
   - Ensuring a culturally safe environment in mental health disorders, including cultural references in manic thoughts/delusions
   - Inequities in hospitalisation rates for bipolar disorders between Maori and non Maori, and application of this to clinical decision making and management
   - Understanding how reduced access to health services and inadequate quality of psychiatric care for Māori, contributes to poor outcomes
Population Health 
   - Epidemiology of bipolar affective disorder
   - Epidemiology of substance abuse
Conditions to be considered relating to this scenario
bipolar affective disorder, post-traumatic stress disorder (PTSD), attention deficit disorder with hyperactivity (ADHD), Cushing's syndrome, hyperthyroidism, anxiety disorder, schizophrenia, steroid use, schizoaffective disorder, substance abuse (especially psychostimulants), cyclothymia
Less common but 'important not to miss'
head trauma, encephalopathy of any cause, brain abscess, Addison's disease, Huntington's disease, multiple sclerosis, systemic lupus erythematosus (SLE), encephalitis, HIV, syphilis
Wilson's disease, normal pressure hydrocephalus, paraneoplastic syndrome, Churg-Strauss syndrome, Behçet’s disease, porphyria, Fahr disease
Related Scenarios
[Major depressive episode]