Bipolar and Mood Stabilisers Flashcards
ICD 10 criteria for diagnosis of Bipolar affective disorder/bipolar
> 2 episodes of disturbed mood -
either depressive
Or manic/hypomanic
ICD-10 symptoms of mania
elated/labile mood increased energy levels distractibility reduced need for sleep grandiosity disinhibition (financially, sexually) reckless behaviour increased libido racing thoughts / flight of ideas psychotic symptoms
Difference between a manic and hypomanic episode?
Mania - clustering of symptoms, usually for >1 week, +/- psychosis. typically more severe, greater interference with ADL
Hypomania - fewer symptoms, less severe. Typically lasting >4 days. Never with psychosis
Investigations for BAD/mania
PHQ-9
Baseline exclusion bloods for organic causes - FBC, TFTs, toxicology screen
Management of Mania - acute presentation
For agitation - try short acting Benzo - IM Lorazepam
AND - start atypical Apx - Olanzapine, aripiprazole
Principles of management of Mania
For sleep disturbance - temazepam, zopiclone
Once commenced on an antipsychotic –> then can start mood stabiliser
Commence patient on Lithium / or other mood stabiliser - valproate, carbamazepine
Can also offer high intensity CBT, but medication will be principle therapy
what is the therapeutic window of Lithium
aim for 0.4 - 1.0 mmol/L
>1.2mmol/L can be toxic
Can’t stop suddenly - may get rebound hypomania/mania
What tests should be ordered before commencing Lithium treatment?
TFTs - Lithium can be thyrotoxic - treat with levothyroxine
ECG
Renal function - serum creatinine and eGFR
beta-hCG - exclude pregnancy
What is the schedule of monitoring, AFTER commencing lithium treatment
Check lithium levels:
5 days after
then.. every week - until stable for 4 weeks
then.. every 3 months
Check bloods 12 hrs after final dose increment
Check TFTs, U&Es, Calcium every 6 months
Think also about pregnancy test
Pneumonic for things to remember with Lithium
LMNOP L - lithium side effects M - motor - tremor, dysarthria N - nephrotoxicity O - hypothyroidism P - pregnancy - 1st trimester CI, ebstein's anomaly
What are the common side effects with lithium therapy
GI upset, nausea, vomiting, abdo pain, metallic taste in mouth
Urinary - thirst, polyuria, impaired urine concentration
weight gain
oedema
Features and management of lithium toxicity
Dysarthria, ataxia, coarse tremor
marked GI upset
dropped GCS, seizures
Benzos for seizures, vigorous fluids to remove excess lithium
Discontinue lithium treatment
What may precipitate lithium toxicity
Increased serum concentration caused by:
Dehydration - illness, N+V, diuretics
Renal impairment - NSAIDs, ACEi, ARBs
