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RC Nuggets > Bipolar > Flashcards

Bipolar Flashcards

1
Q

Suicide risk in BAD?

A

15-19%
Equal risk in BAD I and 2
But more completed in BAD 2 (4%)

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2
Q

Conversion rate from MDD to BAD?

A

5-10% (adults)

20-40% (CAP)

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3
Q

BAD genetics?

A

CACNA1C on 12p3
ANK3
COMT
BDNF

More cohort effect than MDD

1 parent = 25%
2 parents = 50-75%
MZ twins = 45-70%
1st degree relative = 5-10%

Functional imaging:

  • HYPO in PREFRONTAL
  • HYPER in LIMBIC
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4
Q

BAD co-morbidities?

A

Anxiety disorders (75%) –> most common OCD, more co-morbid in kids than adults

Substance use disorder (33-45 or 50%)

Personality d/o (42%) –> OCPD (18%), BPD (16%), avoidant (12%), paranoid (11%), histrionic (10%)
ADHD

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5
Q

Mania criteria

A

Expansive/irritable mood +
Increased energy +
at least 3/7 (4 if mood irritable)

x 1 WEEK (less if hospitalized)

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6
Q

Hypomania criteria

A

x 4 DAYS
No psychotic symptoms
No hospitalization

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7
Q

Cyclothymia

A

At least 2 YEARS
(1 year in CAP)

Symptoms present for at least HALF the time
Never without symptoms for more than 2 MONTHS

Criteria for a major depressive, manic or hypomanic episode have never been met

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8
Q

Rapid cycling

A

4 episodes in 12 months
13-20% BAD
No family risk (not genetic)

Associated with
women
antidepressant
substances
hypothyroid
BAD2
menopause
temporal lobe dysfunction
alcohol/caffeine
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9
Q

BAD co-morbid with ADHD

A

Stabilized with mood stabilizer/AP FIRST
Then
Adjunct methylphenidate or amphetamines

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10
Q

BAD in elderly

A

Lithium level 0.4-0.7
RISPERDAL if need an AP

BAD increases risk of Alzheimer’s (MORE THAN MDD)

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11
Q

BAD co-morbidities in kids

A 
ADHD (90% kids, 50% adults)
ODD (80%)
Anxiety d/o (52%)
OCD
CD

KIDS HAVE ++ PSYCHOTIC SYMPTOMS IN BAD BUT LESS PSYCHOTIC SYMPTOMS IN MDD COMPARED TO ADULTS

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12
Q

Psychological treatment in maintenance?

A

1st line PSYCHOEDUCATION

2nd line CBT, family-focused therapy

3rd line IPSRT, peer support

Adjunctive psychosocial treatment reduces recurrence rates by about 15%!

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13
Q

Psychological treatment in bipolar depression?

A

2nd line CBT, FFT, IPSRT

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14
Q

Treatment of agitation in BAD

A 
1st line 
ABILIFY IM
ATIVAN IM
LOXAPINE INHALED (level 1)
OLANZAPINE IM
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15
Q

Acute mania response rate?

A

50% respond to mono therapy in 3-4 weeks

Combination treatment is more efficacious than Lithium or Epival alone

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16
Q

Acute mania treatment?

A 
Monotherapy:
LITHIUM
SEROQUEL
EPIVAL
Asenapine
Abilify
Invega
Risperdal
Cariprazine
Combo:
SEROQUEL + Li/DVP
ABILIFY + Li/DVP
RISPERDAL + Li/DVP
Asenapine + Li/DVP

2nd line: Zyprexa, Tegretol, Lithium + DVP, ECT, Haldol

17
Q

Most common suicide method in BAD depression?

A

Self-poisoning (medication, drugs)

18
Q

Treatment BAD1 depression?

A 
1st line
SEROQUEL
LATUDA + LI/DVP
LITHIUM
LAMICTAL (mono or adjunct)
LATUDA
2nd line
EPIVAL
SSRI/Wellbutrin adjunct
ECT
Cariprazine
Zyprexa + Prozac

NOT RECOMMENDED:
Abilify
Antidepressant mono therapy

19
Q

BAD 1 maintenance treatment?

A 
1st line
LITHIUM
SEROQUEL
EPIVAL
LAMICTAL
ASENAPINE
SEROQUEL + LI/DVP
ABILIFY + LI/DVP
ABILIFY
20
Q

BAD guideline nuggets?

A

EPIVAL ONLY 2ND LINE IN BIPOLAR 1 DEPRESSION

LATUDA NOT FOR MAINTENANCE

LITHIUM + EPIVAL COMBO ONLY 2ND LINE IN MANIA

PSYCHOEDUCATION ONLY 1ST LINE IN MAINTENACE

NO FIRST LINE THERAPY IN BIPOLAR DEPRESSION
2ND LINE THERAPY IN BIPOLAR DEPRESSION = CBT AND FFT

ONLY FIRST LINE IN BAD2 DEPRESSION IS SEROQUEL
MONOTHERAPY WITH ZOLOFT AND EFFEXOR SECOND LINE

NO LATUDA OR EPIVAL IN BIPOLAR 2!!

BAD 2 MAINTENANCE 2ND LINE IS EFFEXOR OR PROZAC MONOTHERAPY

LATUDA ONLY FIRST LINE IN DEPRESSION IN KIDS
EPIVAL ONLY FOR MAINTENANCE IN KIDS
SEROQUEL ONLY FOR MANIA IN KIDS (and lower down)

21
Q

Hypomania treatment?

A

Same as mania!

22
Q

Bipolar 2 depression treatment?

A

1st line
SEROQUEL

2nd line
LITHIUM
LAMICTAL
WELLBUTRIN ADJUNCT
ECT
ZOLOFT
EFFEXOR XR

NOT RECOMMENDED = Paxil

23
Q

Bipolar 2 maintenance treatment?

A

1ST LINE
SEROQUEL
LITHIUM
LAMICTAL

2nd LINE
EFFEXOR
PROZAC

24
Q

Child and adolescent BAD treatment

A

MANIA

1ST LINE 
LITHIUM
RISPERDAL
ABILIFY
ASENAPINE
SEROQUEL

DEPRESSION

1ST LINE
LATUDA

2ND LINE
Lithium
Lamictal

MAINTENANCE

1ST LINE
ABILIFY
LITHIUM
EPIVAL

25
Q

Geriatric BAD treatment

A

MANIA

1ST LINE
LITHIUM
EPIVAL

2ND LINE
Seroquel

DEPRESSION

1ST LINE
SEROQUEL
LATUDA
LITHIUM
LAMICTAL

MAINTENANCE

1ST LINE
LITHIUM
EPIVAL
LAMICTAL

26
Q

BAD co-morbidities treatment

A

ETOH: LITHIUM + EPIVAL COMBO
(Seroquel not effective)

Cannabis: LITHIUM and/or EPIVAL
(Seroquel not effective)

Stimulants: LITHIUM, EPIVAL, Seroquel, Risperdal, Wellbutrin

Opioids: METHADONE

BPD: EPIVAL, LAMICTAL

27
Q

Lithium complications?

A

Hypothyroid
Hypercalcemia
Hyperparathyroidism

28
Q

Epival complications?

A

PCOS
sedation
hyperammonemic encephalopathy

29
Q

Lamictal

A

10% benign rash

0.3-1% serious rash

RC Nuggets (20 decks)

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