Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

year three exam 2 > bipolar clinical > Flashcards

bipolar clinical Flashcards

1
Q

what is bipolar disorder

A

stages of mania/hypomania and depression, with potentially stable moods between episodes - functioning is impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

epidemiology of bipolar disorder

A

1% of population
commonly between 18-24 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the risk factors for bipolar disorder

A

genetics
being male
exposure to triggers
- trauma
- sudden cessation of mood stabiliser
- ECT
- goal attainment events
- disrupted circadian rhythms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the physical risks of bipolar disorder to the patient

A

obesity
heart disease
HTN
poor memory
higher death risk by infection of respiratory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the mental risks of bipolar disorder to the patient

A

greater suicide risk
substance misuse issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the social risks of bipolar disorder to the patient

A

poor performance
financial issues
violence/promiscuity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which drugs can cause drug induced bipolar

A

hallucinogens
CNS stimulants - amphetamines, caffeine
antidepressants
antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the differential diagnosis for bipolar disorder

A

schizophrenia
unipolar depression
substance misuse
ADHD
BPD
SAD
PTSD
anxiety
organic causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the 4 types of bipolar disorder

A

I - classic manic depression - mania and/or depression
II - depression with at least one hypomanic episode
III- pseudounipolar depression - recurrent mixed states
rapid cycling - 4 + mood episodes in a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the non-pharmacological treatment options for bipolar disorder

A

talking therapies - good for early treatment if given w meds
CBT ineffective
psychotherapy and CBT NICE recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the options for pharmacological treatment for bipolar

A

mania/hypomania acute and relapse prevention
- lithium, valproate, olanzapine, quetiapine, aripiprazole (carbamazepine, risperidone, benzos, haloperidol)
bipolar depression
- lithium, quetiapine
(carbamazepine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the indication for quetiapine

A

Monotherapy for acute mania/depression and relapse prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what monitoring is required for quetiapine, olanzapine and aripiprazole

A

weight/BMI - weekly for 6 them at 12 weeks
HbA1c
Lipids - before and at 12wks
ECG
BP/pulse - after each dose change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the side effects of quetiapine

A

sleepiness
dizziness
dry mouth
weight gain
postural hypotension
anticholinergic s/e

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the indication for olanzapine

A

mania and relapse prevention who are lithium/valproate non-responders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

olanzapine s/e

A

sedation - take on
weight gain
postural hypotension
anticholinergic s/e
metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

interaction between olanzapine and smoking

A

induces CYP1A2 - metabolises olanzapine - do not stop if already smoker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the indication for aripiprazole

A

acute mania and relapse prevention in people who have responded acutely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

aripiprazole s/e

A

akathisia
insomnia
gi upset
EPSEs
postural hypotension
palpitations

20
Q

what is the indication for lamotrigine in BD

A

prevention of relapse of bipolar depression

21
Q

lamotrigine s/e

A

drowsiness
dizziness
headache
nausea
oedema
bone marrow suppression
stevens johnsons syndrome

22
Q

prescribing warnings with lamotrigine

A

titration must be by the book - low and slow as per BNF

23
Q

what is the indication for valproate in BD

A

mania and relapse prevention
- depakote and episenta

24
Q

what are the monitoring requirements for valproate in BD

A

height
weight
FBCs
LFTs - before and over 6-12m
blood cell count - before and at 6m

25
Q

valproate s/e

A

weight gain
gi irritation
diarrhoea
hair loss
hepatic dysfunction
thrombocytopenia

26
Q

what is mania

A

elevated mood for 7 days or more, with severe functional impairment and psychotic features

27
Q

what is hypomania

A

elevated mood for 4 days, with increased or decreased function and no psychotic features

28
Q

what are the diagnostic symptoms of mania/hypomania

A

abnormal elation of mood
inability to concentrate
flight of ideas
obsessive preoccupation with an idea
overactive/intrusive
risk taking

29
Q

what are the presenting symptoms of mania/hypomania

A

euphoric mood
bright/untidy appearance
low sleep requirements
increased drive/energy
reduced insight
pressure of speech

30
Q

what is bipolar depression

A
  • Symptom or part of bipolar mood disorder including other phases
    • Antidepressants usually ineffective
31
Q

what are the symptoms of bipolar depression

A

decreased energy
badly sleeping
doing less
loss of interest

32
Q

what is the indication for lithium in BD

A

1st line in prevention of bipolar relapse - depression and mania

33
Q

what is the MOA of lithium

A

alkali metal - not fully understood, modifies production and turnover of certain neurotransmitters

34
Q

what are the C/I for lithium

A

hypersensitivity
cardiac disease/insufficiency
low sodium
severe renal impairment
addisons disease
untreated hypothyroidism
breastfeeding
brugada syndrome

35
Q

cautions in using lithium

A

renal impairment
avoid in pregnancy
ECT and other meds that reduce epileptic threshold
QTc prolongation and other meds that do so

36
Q

lithium monitoring requirements

A

ECG
RF (6m)
thyroid (6m)
weight/bmi
calcium
U&Es
FBC
plasma - weekly til stable for 4 weeks then 3m for 1 year, then 6m

37
Q

which groups of patients are at risk for high/low lithium plasma levels

A

elderly
risk of impaired renal/thyroid function
raised calcium
poor adherence
poor symptom control
>0.8mmol/L on last bloods

38
Q

how are lithium serum levels tested

A

blood test - 12hr post dose - 0.1-1.1mmol/L

39
Q

what are the side effects of lithium

A

upset stomach
fine tremor of hands
metallic taste
ankle oedema - reduce dose
increased thirst ad urine - RF
weight gain

40
Q

what levels is lithium toxic

A

> 1.5 is fatal >2mmol/L is urgent

41
Q

what are the symptoms of lithium toxicity

A

severe hand tremor
nausea
diarrhoea
muscle weakness
slurring
blurred vision
confusion

42
Q

which medications can increase lithium levels

A

NSAIDs
ACEi/ARB - increased reabsorption in kidney
COX2i
metronidazole
SSRIs
diuretics

43
Q

which medications can decrease lithium levels

A

sodium bicarbonate
caffeine

44
Q

what is the interaction between lithium and amiodarone

A

ventricular arrythmia

45
Q

what are the counselling points for lithium

A

OD night - minimise renal damage
6m to fully establish
take regularly
stop over 4 weeks minimum

46
Q

bipolar pathophysiology

A

dendritic spine loss, altered cellular connectivity and neural plasticity

year three exam 2 (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions