Bipolar Affective Disorder Flashcards
What is the general age of onset of bipolar?
15-19 years
How is bipolar characterised?
High moods (mania) Low mood (depression)
What is the difference between bipolar 1 and 2?
1 - At least one manic episode with or without history of major depressive episodes
2 - One or more depressive episodes and at least on hypomanic episode (no evidence of mania)
Define mania
Distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least a week
What must accompany mania?
At least 3 of: Increased energy/activity Incomprehensible speech Flight of ides Poor concentration Disinhibition Extravagant or impractical plans Delusions Hallucinations
What is hypomania?
Similar to mania but only lasts 4 days
Doesn’t cause marked impairment or hospitalisation
No psychosis
How is mania treated?
Consider stopping antidepressants
Max dose mood stabiliser
Antipsychotics
Lithium or valproate if antipsychotic not effective alone
What is the treatment for moderate to severe bipolar depression?
Max dose mood stabiliser
Fluoxetine and olanzapine or quetiapine
Lamotrigine if no response
What should be used in an acute episode of bipolar depression?
Lithium
Valproate, Olanzapine, Quetiapine if not an option
What could cause a relapse?
Lack of adherence in ‘well’ phases
Describe the pharmacokinetics of lithium treatment
Steady state in 4-7 days
Narrow therapeutic index (0.4-0.8mmol/L 12 hours after dose)
What are the monitoring requirements for lithium?
Weekly plasma conc. checks, then every 3 months up to a year U&Es eGFR TFTs Bone FBC ECG BMI
What are the side effects of lithium?
Fine tremor Acneiform eruptions Nephrotoxicity Hypothyroidism Hypercalcaemia
What could happen if lithium is stopped abruptly?
Relapse
What should be monitored when giving sodium valproate?
Baseline and regular BMI and FBC checks
LFTs after 6 months and then annually
