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Psyc-2020 > BAD_EO > Flashcards

BAD_EO Flashcards

1
Q

What are the specifiers of a manic episode? (Total=7)

A 
Anxious distress
Psychothic features
Mixed features
Peripartum onset
Catatonia
Remission
Severity
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2
Q

What are the specifiers of depressive episode? (Total=9)

A 
anxious distress
Psychotic features
Mixed features
Atypical features
Melancholic features
Peripartum onset
Catatonia
Remission
Severity
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3
Q

What are the periods where suicides are higher?

A

During hospital admissions (14%) and six weeks after discharge (26%)

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4
Q

What are the main factors associated with suicide deaths ? (Total=8)

A

Male gender
Older age
Current episode of depression(70% of deaths and suicide attemps occur during this phase), mixed or manic with psychotic features
Hopelessness or psychomotor agitation during the current episode
Comorbidity of anxiety disorder
First-degree relatie with mood disorder or suicide
Prior suicide attempt
Psychosocial precipitant present within the first week of death

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5
Q

What are the features suggestive of bipolarity? (Total of 9)

A

Hypersomnia
Hyperphagia
Other atypical depressive sx such as leaden paralysis
Psychomotor retardation
Psychotic features and-or pathological guilt
Lablility of mood: irritability;racing thoughts;psychomotor agitation
Early onset of depression (avant 25 ans)
Multiple prior episodes (plus que 5)
Positive family hx of BAD

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6
Q

What is first-line treatment of adjunctinve psychological treatment of bipolar disorder?

A

Psychoeducation only for maintenance (level 2)

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7
Q

What is second-line recommendation for adjunctive psychological treatment for bipolar disorder?

A

CBT and Family-focused therapy for maintenance and depression

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8
Q

What is third line recommendation for adjunctive psychological treatment of bipolar disorder?

A

IPSRT for maintance and depression

Peer support only for maintenance

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9
Q

What are first line monotherapy agents for mania? (Total=8)

A 
Lithium
Quetiapine
Epival
Asenapine
Aripiprazole
Paliperidone
Risperidone
Cariparazine
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10
Q

What are first-line combination therapy for mania? (Total=4)

A

Quetiapine+Li-DVP
Aripiprazole +Li-DVP
Risperidone +Li-DVP
Asenapine +Li-DVP

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11
Q

Percentage of response in mania?

A

50% to monotherapy within 3-4 weeks. 20% more to combination thx.

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12
Q

Lithium is preferred over epival when individual displays which features?

A

Classic euphoric grandiose mania
Few prior episodes of illness
A mania-depressive-euthymic course of disease
Family hx of lithium response

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13
Q

Epival is preferred over lithium in individuals who display which features?

A 
Equally effective in those with classical and dysphoric mania
Multiple prior episodes
Predominant irritable mood
Comorbid SUD
History of head trauma
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14
Q

Carbamazepine may be preferred in individuals who display which features?

A

History of head trauma
Comorbid anxiety and substance use
Schizoaffective presentation with mood-incongruent delusions
Negative hx of BAD in first-degree relatives

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15
Q

Which tx has evidence for mixed features in mania?

A

Combination therapy with atypical antipsychotics and epival.
Asenapine, aripiprazole, olanzapine and ziprasidone have been shown to be equally effective in tx mania with mixed features.

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16
Q

Which medication may have specific anxiolytic benefits to treat mania with anxious distress?

A

Epival, quetiapine, olanzapine and carbamazepine.

17
Q

What are the first-line treatments for depression in BAD1? (Total=6)

A 
Quetiapine
Lurasidone +Li-DVT
Lithium
Lamotrigine
Lurasidone
Lamotrigine + Li-DVT
18
Q

What are the second-line tx for depression in BAD1? (Total=5)

A 
DVT
SSRIs-Bupropion
ECT
Cariprazine
Olanzapine-fluoxetine
19
Q

In BAD1-depression episode, a lack of improvement is predictor of non-response after how long ?

20
Q

Name a few third line therapy for BAD1-depression episode

A 
Aripiprazole (level 4)
Carbamazepine (level 2)
Olanzapine (level 1)
Modafinil adj (level 2)
Synthroid adj (level 3)
TMSr adj (level 2)
21
Q

Name good agents to help with anxious distress in BAD1-depression episode

A

Quetiapine
Lurasidone
Olanzapine-fluoxetine

22
Q

Name a good treatment for melancholic features in BDA1-depression episode

23
Q

What is associated with rapide cycling that you need to rule out before choosing an agent?

A

Hypothyroidism
Substance use
Antidepressants

24
Q

Best agents for in the acute and maintenance phases (i.e. to consider if rapid cycling patients)

A

Quetiapine
DVP
Lithium
Olanzapine

25
Q

What are the risk features of recurrence of a mood episode in BAD1?

A 
Younger age of onset
Psychotic features
Rapid cycling
More (and more frequent) episode
Comorbid anxiety and SUD
26
Q

What are the first-line tx for maintenance in BAD1? (Total=8)

A 
Lithium
Quetiapine
DVP
Lamotrigine
Asenapine
Quetiapine +Li-DVP
Aripiprazole + Li-DVP
Aripiprazole (PO and LAI)
27
Q

What are second line tx recommended in maintenance in BAD1?

A 
Olanzapine
Risperidone (LAI)
Risperidone LAI adj
Carbamazepine
Paliperidone
Lurasidone + Li-DVP
Ziprasidone + Li-DVP
28
Q

What are the recommendations for tx of acute hypomania in BAD2?

A

Lack of evidence.
When hypomania is frequent, severe, or impairing, clinicians should consider mood stabilizers such as lithium and DVP and-or atypical antipsychotics.

29
Q

What are the first-line and second-line tx for acute depression in BAD2? (Total=1 ; 6)

A 
First-line: quetiapine (L1)
Second-line:
Lithium L2
Lamotrigine L2
Buproprion adj L2
ECT L3
Sertraline L2
Venlafaxine L2
30
Q

What are tx recommendations for maintenance of BAD2?

A

First-line:
Quetiapine
Lithium
Lamotrigine

Seconde-line: venlafaxine

31
Q

SSx of lithium toxicity?

A

Neuro: tremors, fasciculations, weakness, confusion, seizures, coma
GI: No, Vo, Do and cramps
Cardio: flattening of T waves and arrythmias
Thyroid: coma myxoedemateux
Renal: acidose renale tubulaire, AKI

32
Q

Tx of lithium toxicity?

A 
Fluids +++
Hemodyalysis if :
- Li level superior to 4mmol
-Li level superior to 2.5mmol and symptomatic
-Sx neurologic (eg seizures)
33
Q

What increases Lithium level and what decreases li level?

A

Increase:

  • NSAIDs
  • ACE-inhibitors
  • ARBs
  • Thiazides
  • Calcium channel blockers
  • decrease of salt in your diet
  • dehydration

Decreases:

  • Caffein
  • Theophiline
  • spironolactone
34
Q

What is the half life of valproate?

A

5 to 20 hours

So, BID administration

35
Q

Dosing of valproate?

A

Loading dose 20-30mg-kg-day
Then 15mg-kg-day
Increase by 250-500 Q1-3day to reach 525 to 850 umol-L (700 in maintenance). Max usually 60mg-kg

36
Q

Side effects of valproate?

A 
GI 
sedation
hair loss
leucopenia and thrombocytopenia
Hepatotoxicity (if combined with other anticonvulsivant or liver disease)
Weight gain
Pancreatits
PCOS
Tremor
37
Q

Explain drug interaction between valproate and lamictal.

A

Valproate inhibits glucouride conjugation which increases lamictal level. When lamictal prescribed with valproate, reduce lamictal dose by 50%

Psyc-2020 (41 decks)

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