Bipolar Flashcards
What is bipolar disorder?
cyclical mood disorder (mania, depression)
What can induce bipolar disorder? (4)
- antidepressants, CNS stimulants -> induce mania (increase NA/DA transmission)
- drug withdrawal (alcohol, benzodiazepines, antidepressants, opioids, barbiturates)
- CNS disorders (strokes, head injuries)
- endocrine / hormonal dysregulation (thyroid, Cushing’s)
Clinical presentation of mania?
DIGFAST
Distractibility & easily frustrated
Irresponsibility & erratic uninhibited behaviour
Grandiosity (inflated self-esteem)
Flight of ideas (racing thoughts)
Activity increase
Sleep less
Talkativeness
Duration of sx for bipolar to be considered?
- major depressive sx
- manic sx
- hypomanic sx
- major depressive sx >2w (functional impairment)
- manic sx ≥1w (functional impairment)
- hypomanic sx ≥4D (no functional impairment or psychosis), eventually becomes manic
Types of bipolar?
- Bipolar I: mania +- depressive episodes
- Bipolar II: hypomania + depressive episodes
Nonpharm for bipolar?
- psychoeducation about disorder, tx & monitoring
- psychotherapy, interpersonal therapy, CBT
- stress reduction, relaxation therapy
- sleep hygiene
- nutrition
- exercise
How fast do meds work for bipolar?
3-5D
Treatment options for mania? (1st line and others)
1st line: lithium (maintenance & relapse/suicide prevention)
Others: antipsychotics (olanzapine, quetiapine, risperidone, aripiprazole, haloperidol), valproate, carbamazepine
Treatment options for bipolar depression? (1st line & others)
1st line: lithium (maintenance & relapse/suicide prevention)
Others: antipsychotics (quetiapine, olanzapine + fluoxetine, lurasidone, cariprazine), lamotrigine
Which drug used for bipolar depression does not have anti-manic properties, and which drug used for mania does not have antidepressant effects?
No anti-manic: lamotrigine
No antidepressant: haloperidol
What role do benzodiazepines have in bipolar?
Help pt relax & sleep (short course, PRN)
Main goals of therapy for bipolar?
- reduce frequency, severity & duration of mood episodes
- prevent suicide
Side effects of lithium? (5)
- tremors, fatigue, cognitive impairment
- polyuria, diabetes insipidus
- hypothyroidism
- ECG changes
- N/V/D, weight gain
Does lithium require TDM?
Yes
Toxicity levels of lithium:
- mild
- moderate
- severe
- mild: 1.5-2.0
- moderate: 2.0-2.5
- severe: >3.0
Side effects at different toxicity levels of lithium?
- mild (7)
- moderate (8)
- severe (7)
- mild: N/V, loose stools, lethargy, drowsy, lightheaded, confusion, coarse hand tremors
- moderate: severe N/V/D, ataxia, slurred speech, blurred vision, worsening confusion, profound lethargy, tinnitus, apathy
- severe: severe N/V/D, seriously impaired consciousness, increase deep tendon reflexes, stupor, coma, seizures, death
Target lithium levels:
- acute mania
- maintenance
- acute mania: 0.8-1.0
- maintenance: 0.6-1.0
DDI with lithium?
STAND (increase Li)
- sodium depletion
- thiazides
- ACEi/ARB
- NSAIDs
- dehydration
+ fluoxetine
+ neurotoxicity (with carbamazepine, phenytoin, non-DHP CCB, losartan, methyldopa, metronidazole)
+ caffeine & theophylline (increase renal elimination of Li)
When to switch / add another drug for bipolar?
No response within 2-4w
How is lithium eliminated?
Renal elimination
