Bipolar

Question 1

Bipolar disorder

Answer 1

Characterised by extreme mood swings.
Episodes can last several weeks or months.

Question 2

Types of bipolar episodes

Answer 2

Mania = feeling very high and overactive. Less severe mania is known as hypomania.

Depression = feeling very low and lethargic.

Question 3

Acute episodes of mania/hypomania

Answer 3

BDZ
- Short term use only
- Risk of dependence

Antipsychotics (QOR)
- Quetiapine
- Olanzapine
- Risperidone
- Lithium or valproic acid is added to antipsychotic if response inadequate.
- Asenapine in moderate-severe manic episodes.

Question 4

1st generation antipsychotics (typical)

Answer 4

Haloperidol
Chlorpromazine
Flupentixol

Question 5

2nd generation antipsychotics (atypical)

Answer 5

Quetiapine
Olanzapine
Risperidone
Clozapine

Question 6

Atypical antipsychotics - MoA

Answer 6

Block post-synaptic dopamine (D2) receptors.
Also have activity at other receptors (5-HT2A)

Compared to typical antipsychotics:
- Greater activity at other receptors (antagonism of 5-HT2A)
- Looser binding to D2 receptors.
- Lower risk of extrapyramidal symptoms.
- More efficacious in treatment resistant schizophrenia.

Question 7

Atypical antipsychotics - General side effects

Answer 7

Metabolic disturbances
- Weight gain
- Diabetes
- Lipid changes

Prolong QT interval
- Arrhythmias

Question 8

Risperidone - Side effects

Answer 8

Increased prolactin
Breast symptoms (men and women)
Sexual dysfunction

Question 9

Clozapine - RARE side effects

Answer 9

Agranulocytosis (severe deficiency of neutrophils) = severe infections
Myocarditis

Question 10

Antipsychotics - caution

Answer 10

CVD disease

Question 11

Antipsychotics - DO NOT USE IN

Answer 11

Severe heart disease
History of neutropenia

Question 12

Antipsychotics - interactions

Answer 12

Antiemetics that block D2 receptors
- metoclopramide

Drugs that prolong QT interval
- amiodarone
- quinine
- macrolides
- SSRIs

Question 13

Prophylaxis of bipolar disorder

Answer 13

Long-term treatment of disorder for at least
two years from the last manic episode, and up to five years if the patient has risk factors for relapse.

Lithium salts
Valproate (as valproic acid or sodium valproate)
Olanzapine (if response in manic episode)
Carbamazepine (rapid-cycling bipolar disorder unresponsive to other drugs, particularly lithium)

Question 14

Bipolar disorder - contraindications

Answer 14

Do not give antidepressants to those with:
- Rapid cycling bipolar disorder
- Recent history of hypomania/manic episode
- Rapid mood fluctuations