Bipolar

Question 1

For mania what are the treatment guidelines

Answer 1

1. Two or three drug combinations
   
   1. Lithium
   2. VPA
   3. SGA
2. • BZD =- Antipsychotic
3. Dont combine antipsychotics together
4. Alternatives CBZ then Oxcarbazepine

If these dont work use three drug therapy

• Lithium + Anticonvulsant + AP
• Anticonvulsant + Anticonvulsant + AP

Last is ECT

Question 2

Non pharm treatment for bipolar disorder?

Answer 2

• Psychotherapy
• Support group
• ECT

Question 3

In a rapid cycler what meds can be used?

Answer 3

• Valproic acid is preferred
• Alternatives Carbamazepine, Lamotrigine, Combo therapies

Question 4

Some is classified as being Bipolar 1 if?

Answer 4

They have had a manic episode

Question 5

What are some medical conditions that can cause mania or hypomania?

Answer 5

• Alzheimers
• AIDS
• Epilepsy (temporal lobe)
• Hemodialysis
• Hyperthyroidism
• Neurosyphillis
• Surgical trauma
• Post-concussion/head injury
• CVA
• Postinfection

Question 6

Signs a symptoms of Severe mania

Answer 6

• Often resembles paranoid schizophrenia
• Bizarra behavior
• Hallucinations
• Delusions
• About 2/3 of pts will have psychotic symptoms
• This gets better over time and Schizo wont

Question 7

Signs a symptoms of Mania DigFast

Answer 7

• Distractibility
• Insomnia (Decrease need for sleep)
• Grandiosity
• Flight of ideas
• Activity
• Speech
• Thoughtlessness

Question 8

Hypomania can last for?

Answer 8

4 weeks or longer

Question 9

What are the nonpsychiatric causes of Bipolar disorder?

Answer 9

• Alcohol, illicit drugs
• Anticholinergics
• Antidepressants (Dont give them antidepressants alone)
• Levodopa
• Thyroid supplementation
• Zidovudine
• Drug withdrawals
  
  • Antidepressants
  • Benzos
  • Corticosteroids
  • Mehtyldopa
• ECT
  *

Question 10

Therapy for hypomania

Answer 10

1. Monotherapy
   
   1. Lithium
   2. VPA
   3. CBZ
   4. SGA
2. Can add benzos short term
3. Alternative can be Oxcarbazepine

2 line combination therapy

1. Lithium + Anticonvulsant or SGA
2. Anticonvulsant or SGA

Question 11

Some is classified as bipolar II if they have?

Answer 11

Not had a manic episode but have had hypomania

Question 12

The age of onset for bipolar disorder?

Answer 12

18-44 but most people are diagnosed at when they are less than 30

Question 13

Severe Mania treatment

Answer 13

1. Mood stabalizer
   
   1. Lithium
   2. Quetiapine or Lurasidone
2. Alternative, Lamotrigine, Fluoxetine/Olanzepine combo
3. If psychosis is present as AP

If that doesnt work consider adding antidepressant or use carbamazepine

3rd line Lithium + lamotrigine + antidepressant

or lithium + quetiapine + antidepressant

Lastly use ECT

Question 14

Hypomanic episode?

Answer 14

Increased energy but doesnt effect your daily function.

Question 15

Mania can last for about? Or longer

Answer 15

1 week or longer

Question 16

Untreated episodes can last for?

Answer 16

several months 3-6

Question 17

There are many complications of bipolar disorder what are they?

Answer 17

• The suicide success rate is very high
• Prevalence of substance abuse
• Risky sexual practices

Question 18

What are the treament goals for Bipolar disorder?

Answer 18

• Treat target symptoms of bipolar
• Prevent relapse
• Prevent suicide
• Minimize adverse events and DI
• Improve QOL
• Medication adherence

Question 19

A rapid cylcler is classified as?

Answer 19

Someone who has 4 or more manic or depressive episodes

Question 20

Manic depression?

Answer 20

Effects daily function, often end up in jail or the hospital