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Psychopharmacotherapy > Bipolar and Related Disorders > Flashcards

Bipolar and Related Disorders Flashcards

1
Q

What are the 5 broad catagories of bipolar symptoms?

A

Manic behavior
Dysphoric behavior
Psychotic
Cognitive

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2
Q

What are some examples of manic behavior (ie positive symptoms)?

A 
Euphoria
Grandiosity
Pressured speech
Impulsivity
Excessive libido
Recklessness
Social intrusiveness
Diminished need for sleep
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3
Q

What are some examples of dysphoric behavior (ie negative symptoms)?

A 
Depression
Anxiety
Irritability
Hostility
Violence or suicide
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4
Q

What are the psychotic symptoms?

A

Delusions

Hallucinations

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5
Q

What are the cognitive symptoms?

A

Racing thoughts
Distractiblity
Disorganization
Inattentiveness

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6
Q

Which bipolar disorder is rapid cycling more commonly associated with?

A

BP II

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7
Q

What are the risk factors for rapid cycling?

A

Female
Antidepressant use
Thyroid disease
Older age

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8
Q

What percentage of BP patients have SI? What percent attempt? What percent succeed?

A

50%
25%
11-19%

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9
Q

When are BP patients most likely to use alcohol or other drugs?

A

During manic episodes

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10
Q

Which BP disorder is most likely to be associated with drugs or alcohol?

A

BP I

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11
Q

What are the two arms of somatic therapy for BP disorder?

A

Psychotropics and ECT

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12
Q

What is the goal of treatment for BP disorder?

A

Treat both mania and depression
Prevent recurrence
Improve quality of life between episodes

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13
Q

What area must be routinely monitored while BP patients are being treated?

A 
Suicide risk
Mood symptoms and activity patterns
Substance use
Sleep hygiene- Change can precipitate symptoms
Medication compliance
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14
Q

What labs should be checked before starting a patient on lithium?

A 
CBC
EKG
Electrolytes
Renal panel- BUN, creatinine, and UA
Thyroid panel 
TSH
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15
Q

What labs should be ordered before starting a patient on valproate?

A

LFTs

CBC

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16
Q

What labs should be ordered before starting a patient on carbamazepine?

A 
CBC
Platelets
UA
LFT
Kidney function
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17
Q

What aspects of Bipolar disorder is lithium effective at treating?

A 
Acute mania (60-80%) & bipolar depression 
Maintenance
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18
Q

What is the main disadvantage of using lithium?

A

Narro theraputic index

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19
Q

What is the target blood level of lithium for acute mania? Maintenance?

A
  1. 8 to 1.2

0. 4 to 1.0

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20
Q

How long do you wait before checking blood levels after starting lithium?

A

4 days

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21
Q

At what blood level will mild lithium toxicty present and how does it present?

A

1.2-1.5
Many general symptoms
Key: Fine hand tremors

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22
Q

At what blood level with moderate lithium toxicty present and how does it present?

A 
1.5 to 2.0
Gross neurological deficits
- Ataxia
- Nystagmus
- Coarse tremors
- Muscle fasciculations
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23
Q

At what blood level is severe lithium toxicity reached and how does it present?

A 
2.5
Delirium
Seizures
Brain damage
Resp. problems
Coma
Death
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24
Q

What do patients need to be sure they do when taking lithium?

A

Stay hydrated

25
Q

What are some predictors that a patient will respond poorly to lithium?

A 
Mixed states
Rapid cycling
Young males
Poorly compliant
Head injuries
Severe mania
Comorbidity
26
Q

What are the two second generation antiepileptic medications used for BP?

A

Divalproex/Valproic acid/Depakote

Carbamazepine

27
Q

When are second generation antiepileptic drugs effective for treating BP disorder?

A

Acute mania

Patients with poor response to lithium

28
Q

At what blood level is divalproex most effective?

A

60 to 90

100 to 120 in special circumstances

29
Q

What are key side effects of divalproex?

A 
GI distrubance
Weight gain
Hepatic dysfunction
Tremor 
Sedation
Hair loss
30
Q

What are the most common side effects of carbamazepine?

A 
Induction of liver enzymes
Sedation
Tremor
Weight gain
Rash
31
Q

What needs to be monitored for all patients taking a second generation antiepileptic?

A

Plasma levels
Hematologic indices
Hepatic indices

32
Q

What are the thrid generation antiepileptics used for BP disorder?

A

Lamotrigine- Lamictal
Gabapentin- Neurontin
Topiramate- Topamax
Oxcarbazepine- Trileptal

33
Q

When is lamotrigine effective for treating BP?

A

Acute and prophylactic bipolar depression

34
Q

What is a major benefit of using a third generation antiepileptic?

A

No blood monitoring

35
Q

What is the main side effect associated with lamotrigine?

A

Cutaneous rash

May progress to stevens-johnson syndrome

36
Q

What populations are at an increased risk of a cutaneous reaction when using lamotrigine?

A

Preadolescents
Rapid titration
Combined with other agents that may decrease metabolism (divalproex)

37
Q

When is gabapentin a good adjunct treatment for bipolar?

A

When anxiety and neuropathic pain are involved

38
Q

When is topiramate a good adjunct for treating bipolar?

A

When there is significant weight gain or risk of weight gain

39
Q

What is the benefit of using oxcarbazepine instead of carbamazepine?

A

Better tolerated
Fewer CNS side effects
Fewer DDI

40
Q

What types of sypmtoms is oxcarbazepine effective for treating bipolar?

A

Anti-manic
Anti-mixed
Anit-depressant
(Preliminary evidence only)

41
Q

Which high-potency benzodiazepines are used to treat acute mania?

A

Clonazepam

Lorazepam

42
Q

When might benzos be used in BP?

A 
Acute mania
Insomnia
Aggression
Anxiety
Dysphoria
43
Q

What medications are benzos an adjunct to?

A

Lithium
Carbamazepine
Valproate

44
Q

What type of symptoms are antipsychotics (typical and atypical) mainly used to treat in BP?

A

Manic

Psychomotor agitation

45
Q

What are the atypical antipsychotics used to treat bipolar?

A 
Olanzapine- Zyprexa
Risperidone- Risperdal 
Quetiapine- Seroquel
Ziprasidone- Geodone
Aripiprazole- Abilify
46
Q

What is the benefit of using atypical antipsychotics over typical?

A

Less EPS and TD

47
Q

What is the main disadvantage of using atypical antipsychotics?

A

Weight gain
metabolic syndrome
CV impairments

48
Q

Which atypical is most effective, but worse for side effects?

A

Olanzapine

49
Q

Which atypical has the least side effects, but isn’t quite as effective?

A

Ziprasidone

50
Q

What is a main side effect of all antipsychotics?

A

Sedation

51
Q

What kind of combo therapy may improve outcomes in BP disorder?

A

Mood stabilizers and atypical antipsychotics

52
Q

Acording to the APA, what are the first line drugs that should be used to treat a patient presenting with mania?

A

Lithium or divalproex & an antipsychotic

53
Q

For less ill patients, what are some acceptable monotherapies?

A

Lithium
Divalproex
Olanzapine

54
Q

What is the preferred treatment for mixed episodes?

A

Divalproex

55
Q

What are alternatives to lithium or divalproex?

A

Carbamazepine or Oxcarbazepine

56
Q

According to the APA, what is the appropiate course of action when treating a patient who is already on a mood stabilizer, but presenting with bipolar depression?

A

Optimize the dose

57
Q

According to the APA, what is the appropiate course of action when treating a patient who is presenting with bipolar depression,but they are not on mood stabilizer?
(Consider Mild to moderate, severe, psychotic, and high suicide risk)

A

Mild to moderate- Lithium or lamotrigine
Severe- Antidepressant & mood stabilzer
Psychosis or High suicide risk- Add antipsychotic or ECT

58
Q

What needs to be on the differential for a patient presenting with bipolar symptoms?

A 
Bipolar I
Bipolar II
Cyclothymic 
Substance/Medication induced
Due to another medical condition

Psychopharmacotherapy (8 decks)

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