Bipolar Flashcards
How is bipolar characterised?
Periods of high and low moods
What is bipolar I?
At least one manic episode with or without history of major depressive episodes
What is bipolar II?
One or more major depressive episodes, at least one hypomanic episode
No evidence of mania
Define mania.
Distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week
Severe enough to cause marked impairment in functioning or hospitalisation
What are the features of mania?
Includes psychotic features
At least 3 additional symptoms- increased energy, incomprehensible speech, disinhibition, extravagant plans, delusions, hallucinations
What is hypomania?
Similar to mania
Symptoms lasting 4 days
No psychotic features
Not severe enough to cause marked impairment
Describe the management of mania/hypomania.
Consider stopping any antidepressants
Start or maximise dose of mood stabiliser
Use antipsychotic
Add lithium or valproate if insufficient response
Which anti-epileptic should not be used in mania?
Lamotrigine
Which antipsychotics are first line in mania?
Haloperidol
Risperidone
Olanzapine
Quetiapine
What is bipolar depression?
Symptoms and diagnosis as with unipolar depression
What must be considered in diagnosis of depression?
Bipolar- risk of mania with treatment
Describe the acute management of moderate/severe bipolar depression.
Start or maximise dose of mood stabiliser
Antidepressant AND antipsychotic
Lamotrigine used last line if no response
Which antipsychotics are first line in bipolar depression?
Olanzapine AND fluoxetine
Quetiapine
Olanzapine alone
Describe the long term management of moderate/severe bipolar depression.
Consider drugs used effectively in acute episodes Lithium is most effective Add/switch to valproate Olanzapine Quetiapine
Describe the features of the therapeutic range of lithium,.
4-7 days to reach steady state
12 hours post dosage, range should be 0.4-0.8mmol/L
Checked weekly until stable
Name 2 brands of lithium.
Priadel
Camcolit
How is lithium cleared?
Renally
What monitoring must be done for lithium?
U&Es eGFR TFTs Bone FBC ECG BMI
What drugs does lithium interact with?
NSAIDs
Diuretics
ACE inhibitors
Give two side effects of lithium.
Fine tremor
Acneiform eruptions
What are the signs of lithium toxicity?
Coarse tremor
Diarrhoea
Vomiting
CNS disturbances
Describe the dosing of valproate in bipolar?
Semisodium valproate licensed in bipolar
Not available in liquid form
Twice daily dosing
What monitoring must be done for valproate?
BMI
FBC
LFT
What effects can be seen in a foetus of a woman taking valproate?
Neural tube defects Facial dysmorphism Cleft lip/palate Cardiac, renal and urogenital defects Limb defects
What developmental effects can be seen in child of woman taking valproate?
Developmental disorders
Autistic spectrum disorder
Autism
ADHD
Describe the risk factors for bipolar?
First degree relative with history of bipolar
Black and minority ethnic groups
Psychological factors such as abuse and neglect during childhood
What is the monoamine theory?
Lack of monoamine transmitters cause depression
Excess causes mania
What is the HPA axis theory?
Cortisol and thyroid abnormalities
What is cyclothymia?
Chronic mood disturbance with depression and hypomania symptoms that do not meet a full episode
What is the only antidepressant effect in bipolar?
Fluoxetine
But only in combination with olanzapine
What is the most effective treatment of bipolar?
Lithium
When is lamotrigine licensed in bipolar?
Prevention of depression
