Fast Five Quiz: Are You Prepared to See Patients With Bipolar Disorder?

Stephen Soreff, MD

Disclosures

June 22, 2018

Generally, routine EEG is unnecessary in the evaluation of bipolar affective disorder, or manic-depressive illness. However, some reasons for ordering EEG in patients with bipolar illness may be appropriate and include:

  • EEG provides a baseline and helps to rule out any neurologic problems; use this test to rule out a seizure disorder and brain tumor

  • If electroconvulsive therapy (ECT) is contemplated, an EEG may be helpful; EEG monitoring during ECT is used to determine the occurrence and duration of seizure

  • Some studies have shown that abnormalities in EEG findings have been indicative of anticonvulsant effectiveness; specifically, an abnormal EEG finding may predict the response to valproate

  • Some patients may have seizures when on medications, especially antidepressants; in addition, lithium can cause diffuse slowing throughout the brain

The total value of performing MRI in a patient with bipolar affective disorder, or manic-depressive illness, remains unclear. However, some investigators report that patients with mania demonstrate hyperintensity in their temporal lobes. Although brain imaging such as MRI, positron emission tomography (PET) scanning, and diffusion tensor imaging (DTI) have been used in patients with bipolar disorder, routine use of CT scanning is not indicated.

Many of the antidepressants, especially the tricyclic agents and some of the antipsychotics, can affect the heart and cause conduction problems. Lithium also can lead to changes such as reversible flattening or inversion of T waves on ECG. In older patients with bipolar disorder or manic-depressive illness on lithium or tricyclic antidepressant therapy, a pretreatment ECG is important. Lithium treatment requires periodic monitoring of the lithium blood level.

For more on imaging studies in patients with bipolar disorder, read here.

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