ADHD and Bipolar Flashcards
When can drug treatment be commenced in ADHD?
In patient with ADHD whose symptoms are still causing significant impairment in at least one area of function despite environmental modifications
How do you treat ADHD?
1st line: lisdexamfetamine or methylphenidate (6 week trial)
(dexamfetamine can be tried if the patient is having beneficial reponse to lisdexamfetamine but cannot tolerate its longer duration of effect
2nd lime: atomexetine
3rd line: guanfacine
What is the patient and carer advise for atomoxetine?
suicidal ideation
hepatic impairment
What are the administration instructions for guanfacine
avoid administration with hifh fat meals - may increase absorption
When should antidepressants be avoided in bipolar disporder?
In patients with rapid-cycling bipolar disorder, a recent history or mania or hypomania or with rapid mood fluctuations
What is used to treat acute episodes of mania or hypomania?
Antipsychotics: haloperidol, olanzapine, quetiapine and risperidone
if inadequate response: lithium or valporate may be added
How do you treat moderate to severe manic episodes associated with bipolar?
Asenapine - second generation antipsychotic
What is used for long-term management of bipolar?
Olanzapine - licensed for prevention of recurrence in patients whose manic episode has responded to olanzapine therapy
What is the minimum time antipsychotics should be discontinued over?
4 weeks
When are benzodiazepines used in bipolar?
(e.g. lorazepam)
May be helpful in initial stages of treatment for behavioural disturbance or agitation
Do not use for long periods due to risk of dependence
How long does the prophylactic effect of lithium take to occur?
6-12 months after initiating therpy
When is valproic acid used in bipolar?
Used for treatment of manic episodes associated with bipolar is lithium not tolerated or contraindicated
When is carbamazepine used in bipolar?
long-term management to prevent recurrence of acute episodes in patients unresponsive to lithium therapy
