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Bipolar Flashcards

1
Q

First-line tx for Mania

A
  1. Lithium 0.8-1.2 mmol/L
  2. Quetiapine
  3. Epival
  4. Asenapine
  5. Aripiprazole
  6. Paliperidone
  7. Risperidone
    [8. Cariprazine]

If severe mania, combine a mood stabilizer with an antipsychotic

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2
Q

Second-line tx for Mania

A 
Olanzapine
Carbamazepine
Olanzapine + Li/VPA
Lithium + VPA
Ziprasidone
Haldol
ECT
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3
Q

First-line tx for Bipolar I Depression

A
  1. Quetiapine 300mg daily
  2. Lurasidone + Li/VPA
  3. Lithium 0.8-1.2 mmol/L
  4. Lamotrigine 200+mg daily
  5. Lurasidone
  6. Li + Lamotrigine
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4
Q

Second-line for Bipolar I Depression

A 
VPA
add-on SSRI/Bupropion
ECT
[Cariprazine]
Olanzapine + fluox
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5
Q

First-line for Bipolar Maintenance

A
  1. Lithium 0.6-1 mmol/L
  2. /6. Quetiapine +/- Li/VPA
  3. Epival
  4. Lamotrigine
  5. Asenapine
  6. Aripiprazole +/- Li/VPA, or Maintena
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6
Q

Second-line for Bipolar Maintenance

A 
Olanzapine
Risperidone LAI
Carbamazepine
Paliperidone
Lurasidone + Li/VPA
Ziprasidone + Li/VPA
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7
Q

Psychosocial Tx for Bipolar Maintenance

A

1st - psychoed
2nd line - CBT, FFT
3rd line - IPSRT, peer support

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8
Q

Second-line for Bipolar II Depression

A

Lithium 0.8-1.2 mmol/L
Lamotrigine
ECT
Sertraline or Venlafaxine if NO mixed features

(**Do NOT give Paroxetine)

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9
Q

Psychosocial Tx for Mania

A

None!

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10
Q

How should Lithium be dosed in older adults?

A
  • Start at 150mg qHS
  • Target serum levels for acute tx: 0.4-0.8 mmol/L (as per CANMAT’s medication monitoring section), often needing to go to the upper end of this range = lowest end of the general adult therapeutic range (as per CANMAT’s guidelines for older adults).
  • Subsequent titration based on tolerability and effectiveness.
  • Some older patients will require blood levels similar to the general adult population in order to achieve remission (>0.8)
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11
Q

Psychosocial Tx for Depression

A

2nd line - CBT, FFT

3rd line - IPSRT

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12
Q

First line for Bipolar II Depression

A

Quetiapine

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13
Q

First line for Bipolar II Maintenance

A

Quetiapine
Lithium
Lamotrigine

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14
Q

Second line for Bipolar II Maintenance

A

Venlafaxine

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15
Q

First line for Mania in Youth

A 
Lithium
Risperidone
Aripiprazole
Asenapine
Quetiapine (beware higher risk of metabolic side effects)
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16
Q

First & Second line for Bipolar Depression in Youth

A

1st - Lurasidone

2nd - Lithium & Lamotrigine

17
Q

First line for Bipolar Maintenance in Youth

A

Lithium
Aripiprazole
VPA

Guidelines (3 decks)

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