Bipolar d/o

Question 1

Bipolar
Acute mania 1st line monotherapies

Answer 1

1st line monotherapies:
“LQ DAARP CAR” –> Like a racecar speeding through mania
OR
Loud Queens Dance At A Royal Party Celebration

- Lithium 
- Quetiapine 
- Divalproex 
- Asenapine
- Aripiprazole 
- Paliperidone (>6mg)  
- Risperidone
- Cariprazine

Question 2

Bipolar
Acute mania 1st line combination therapies

Answer 2

1st line Tx: Combination therapies

Queen And Royals Always Lead
Or
Queen Anne Rules All

- Quetiapine + Li/DVP 
- Aripiprazole + Li/DVP 
- Risperidone + Li/DVP 
- Asenapine + Li/DVP

Question 3

Bipolar
Acute mania 2nd line combination therapies

Answer 3

2nd line treatments: Combination therapies

“On Crazy Overdrive, Let’s Zoom Hyper Euphoria!”

- Olanzapine 
- Carbamazepine 
- Olanzapine + Li/DVP 
- Li + DVP 
- Ziprasidone
- Haloperidol 
- ECT

Question 4

MAB 1 chromosomes implicated

Answer 4

18, 21q, 22q

5, 11, 16

Question 5

Mania criteria

Answer 5

Criterion A:
- Elevated or irritable mood + increase of energy (or goal-directed activity)
AND
- 3 of the following (4 if irritability) for at least 1 week:

Distractability
Impulsivity
Grandiosity
Flight of ideas
Agitation (psychomotor)
Sleep
Talkativeness

Question 6

Other specified and related bipolar d/o

Answer 6

1- Short-duration hypomanie episodes (2-3 days) and major depressive episodes
2- Hypomanie episodes with insufficient symptoms and major depressive epi­sodes
3- Hypomanie episode without prior major depressive episode:
Short-duration cyclothymia (less than 24 months)

Question 7

Bipolar acute mania in child/adolescent

1st line meds

2nd line

Answer 7

1st line

Level 1: lithium, risperidone
Level 2: abilify, asenapine, quetiapine

**risperidone preferable to lithium for non-obese youth, and youth with ADHD

2nd line: olanzapine, ziprasidone (level 2)
quetiapine adjunct (level 3)

Question 8

Acute bipolar depression (child/ado)

1st and 2nd line treatment

Answer 8

Acute bipolar depression (child/ado)

1st line:
- Lurasidone (level 2)

2nd line:
- Lithium (level 4)
Lamotrigine (level 4)