Bipolar affective disorder

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Target exams

Red flags

• Mania or mixed features with active suicidal intent, psychosis, or catastrophic risk behaviour — same-day senior review and likely admission; do not leave on an empty safety plan
• First mania after age 40, focal neurology, seizure, fever, or fluctuating attention — intensify organic work-up before locking a primary bipolar label
• Antidepressant monotherapy in known or highly suspected bipolar I — high switch and destabilisation risk
• Lithium toxicity: coarse tremor, ataxia, confusion, vomiting, dysarthria — stop lithium, check level urgently, hydrate, escalate
• Valproate in people who can become pregnant without documented pregnancy-prevention counselling — major teratogen; hierarchy of avoidance
• Postpartum first fortnight in bipolar illness — peak relapse window; protect sleep and re-establish prophylaxis early