Bipolar and Cyclical Mood Disorder Tx

Question 1

Lithium or Depakote for mixed state

Answer 1

Depakote > Li for a mixed state

Question 2

Cyclothymic Disorder

Answer 2

1. Presence of episodes of hypomanic symptoms and depressive symptoms that do not meet criteria for a major depressive episode for the majority of the time over 2 years with no period of absence of symptoms that lasts more than 2 months
2. During this period, no episodes have met criteria for a major depressive episode, manic episode, or mixed episode.
3. If these develop after the initial 2 year period, the diagnosis of cyclothymic disorder will be retained, in addition to the new diagnosis.

Question 3

Stages of Manic Symptoms

Answer 3

Stage I: Hypomania
Stage II: Acute Mania
Stage III: Delirious Mania

Question 4

Stage I: Hypomania

Answer 4

Symptoms not sufficient to require hospitalization or impairment of social or occupational functioning

Question 5

Stage II: Acute Mania

Answer 5

Usually requires hospitalization; marked impairment in functioning of mood, cognition, and perception

Question 6

Stage III: Delirious Mania

Answer 6

Severe clouding of consciousness and intensified symptoms of acute mania

Question 7

Lithium dose range

Answer 7

300-2400 per day

Question 8

Lithium not as effective for

Answer 8

depressive states
rapid cyclers
mixed episodes

Question 9

Lithium Acute Stabilization Blood Level

Answer 9

0.8 to 1.5 mEq/L

Question 10

Lithium prophylaxis/maintenance level

Answer 10

0.6-1.0

Should be hovering around 0.8

Question 11

Effect of Lithium on thyroid

Answer 11

Lithium is known to deplete thyroid stores

Question 12

Li: Initial side effects

Answer 12

GI upset
fine hand tremor
Polyuria, polydipsia

Question 13

Li: Long-term side effects

Answer 13

Wt gain
Dermatological
Leukocytosis
Hypothyroidism
Diabetes insipidus

Question 14

Li toxicity 1.5-2.0 mEq/L

Answer 14

Course tremor, NVD, confusion, ataxia, slurred speech, lethargy–> Hold Li one day and re-evaluate

Question 15

Li Toxicity ≥ 2.0 mEq/L

Answer 15

Profound CNS depression, arrhythmias, szr, coma

Question 16

Depakote dosage range

Answer 16

250-1500 mg/day

Question 17

Depakote for BPD

Answer 17

Used in addition to LI or sometimes as first-line monotherapy for rapid cyclers, effective for mania more than depression

Question 18

Carbamazepine (Tegretol) dosage range and major SEs

Answer 18

200-1600 mg/day

Rash, leukopenia, hepatic dysfunction

Question 19

Lamotrigine dosage range

Answer 19

50-500 mg/day; max 200mg with divalproex sodium (Depakote)

Question 20

Lamotrigine Advantage

Answer 20

Best at managing Bipolar depression

Question 21

Haldol and Depakote

Answer 21

Mild encephalopathy that can mimic EPS, but it is not EPS

Question 22

Dysthymia

Answer 22

2 years of persistently depressed mood
Respond ok to meds
Long delays in seeking treatment
Sx are mild

Question 23

MDD + Dysthymia

Answer 23

“Double depression”

Question 24

Mixed episode criteria

Answer 24

1. Criteria for both a manic episode and for a major depressive episode are met every day during a 1-week period
2. Mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
3. Sx are not due to the direct physiological effects of a substance or a general medical condition.