Bipolar Disorder Flashcards
Difference between bipolar I and II
I: one episode of mania and bouts of intense depression
II: one episode of hypomania lasting 4 or more days and at least one depressive episode
What is hypomania
does not affect social/work functioning or cause psychosis
antipsychotics role in bipolar
Can play a role when mania or pyschosis is occurring but does not stabilize mood traditionally
Mood stabilizers for bipolar
lithium
valproate
lamotrigine
carbamazepine
Role of antidepressants in bipolar
can induce mania as monotherapy so should only be used with a mood stabilizer on board
Manic episode acute treatment first line
valproate, lithium
severe: valproate or lithium + antipsychotic
Depressive episode acute treatment
lithium first line but lamotrigine is used as well
Maintenance therapy first line agents
lithium
valproate
Therapy option in bipolar and pregnancy
lamotrigine
lurasidone has a good safety profile but only indicated in bipolar depression
Lamotrigine dosing pearl
slow titration required due to possibility of rash
SGA used in bipolar
aripiprazole olanzapine quetiapine risperidone ziprasidone lurasidone
lithium therapeutic range (trough)
0.6 - 1.2 mEq/L
Lithium side effects
gi upset cognitive effects tremor polyuria/dypsia weight gain hypothyroidism
signs of lithium toxicity
vomiting, ataxia, coarse hand tremor
CNS depression, arrhythmia, seizure, coma
Things that can increase lithium levels
less salt intake/sodium loss - watch with ACEi/ARBs/diuretics
NSAIDs
