Bipolar Disorder

Question 1

Whats bipolar disorder?

Answer 1

Bipolar disorder, previously known as manicdepressive illness, is a cyclical, lifelong
disorder with recurrent extreme fluctuations
in mood, energy, and behavior.

Question 2

The classification of Bipolar disorder

Answer 2

(1) bipolar I,
• (2) bipolar II,
• (3) cyclothymic disorder, and
• (4) bipolar disorder not otherwise specified.

Question 3

What happens in major depressive episode in a depressive patient?

Answer 3

In bipolar depression, patients often have
mood lability, hypersomnia, low energy,
psychomotor retardation, cognitive
impairments, anhedonia, decreased sexual
activity, slowed speech, carbohydrate craving,
and weight gain.

Question 4

In a MANIAC Episode
What are the symptoms
What are the severe stages
What about marked impairment ?

Answer 4

Acute mania usually begins abruptly, and
symptoms increase over several days.
• The severe stages may include bizarre behavior,
hallucinations, and paranoid or grandiose
delusions. •
There is marked impairment in functioning or the need for hospitalization.

Question 5

What precipitates a maniac episode?

Answer 5

Manic episodes may be precipitated by stressors,
sleep deprivation, antidepressants, CNS
stimulants, or bright light.

Question 6

What happens in hypomaniac episode?

Answer 6

There is no marked impairment in social or
occupational functioning, no delusions, and
no hallucinations. • During a hypomanic episode, some patients
may be more productive and creative than
usual, but 5% to 15% of patients may rapidly
switch to a manic episode.

Question 7

What happens in mixed episode?

40%

Answer 7

often difficult to diagnose and
treat, and are more common in younger and
older patients and females.
Patients with mixed states often have comorbid alcohol and substance abuse, severe
anxiety symptoms, a higher suicide rate, and a
poorer prognosis.

Question 8

What are the risk factors for rapid cycling?

Answer 8

biologic rhythm
dysregulation, antidepressant or stimulant use,
hypothyroidism, and premenstrual and postpartum
states.

Question 9

Prevalence in gender

Answer 9

More in female

Question 10

Suicide Patients prevalence

Answer 10

50%. Bipolar 2 is more prevalent than Bipolar 1 to case this

Question 11

Goals of Treatment

Answer 11

Eliminate mood episode with complete remission of
symptoms (i.e., acute treatment)
• Prevent recurrences or relapses of mood episodes (i.e., continuation phase treatment)
• Return to complete psychosocial functioning
• Maximize adherence with therapy
• Minimize adverse effects
• Use medications with the best tolerability and fewest drug interactions
• Treat comorbid substance use and abuse
• Eliminate alcohol, marijuana, cocaine, amphetamines, and hallucinogens
• Minimize nicotine use and stop caffeine intake at least 8 hours prior to bedtime
• Avoidance of stressors or substances that precipitate an acute episode

Question 12

What are the drugs approved by the FDA for treatment of acute mania in bipolar disorder.

Answer 12

Lithium, divalproex sodium (valproate), aripiprazole,
olanzapine, quetiapine, risperidone, and ziprasidone
Valqroz

Question 13

What drugs are approved for maintenance treatment of bipolar disorder.

Answer 13

Lithium, olanzapine, and lamotrigine

Question 14

What is the antipsychotic that is FDA

approved for bipolar depression.

Answer 14

Quetiapine

Question 15

Lithium is the drug of choice for which bipolar disorders

Answer 15

Euphoric Mania, Acute mania and maintenance
treatment of both bipolar I and II disorders.
For 12 y and older (adult)

Question 16

Sodium Valporoate works better in what conditions?

Answer 16

s valproate has better efficacy
for mixed states, irritable/dysphoric mania, and rapid
cycling compared with lithium.

Question 17

When do we use Sodium Valporoate?

Answer 17

Mood stabilizer;
It is FDA approved only for the treatment of acute manic or mixed episodes, but it is often used as
maintenance monotherapy for bipolar disorder.

Question 18

Whats used for acute and maintenance therapy, but not FDA approved?

Answer 18

Carbamazepine

Question 19

What is approved for the maintenance
treatment of bipolar I disorder. It has been used
as monotherapy or add-on therapy for refractory
bipolar depression.

Answer 19

Lamotigrine

Question 20

Whta drugs are as effective as monotherapy or as add-on therapy to lithium or valproate for acute mania.

Answer 20

Aripiprazole, olanzapine, quetiapine,

risperidone, and ziprasidone

Question 21

What are common alternatives to or in
combination with antipsychotics for acute mania,
agitation, anxiety, panic, and insomnia or in those who
cannot take mood stabilizers.

Answer 21

High-potency benzodiazepines (e.g., clonazepam and

lorazepam)

Question 22

What can be used for acute agitation?

Answer 22

Lorazepam IM may be used for acute agitation

Question 23

Whats added for acute depression?

Answer 23

Antidepressants, except tricyclic antidepressants- increase risk of mania, and bipolar 1 disorder, and rapid cycling

Question 24

Whats better for rapid-cycling bipolar disorder?

Answer 24

Nimodipine may be more effective than verapamil for
rapid-cycling bipolar disorder because of its
anticonvulsant properties, high lipid solubility, and
good penetration into the brain.

Question 25

How to decrease the risk of relapse?

Answer 25

prophylaxis with mood
stabilizers (e.g., lithium or valproate) is recommended
immediately postpartum to decrease the risk of
relapse.

Question 26

Typical or Atypical Antipsychotics are better tolerated

Answer 26

Atypical

Question 27

What drugs are maintenance therapy of bipolar disorder with noncompliance or treatment resistance.

Answer 27

Depot antipsychotics (e.g., haloperidol decanoate,
fluphenazine decanoate, and risperidone long-acting
injection)

Question 28

What’s FDA approved for maintenance

treatment

Answer 28

Olanzapine

Question 29

What’s FDA approved for bipolar

depression.

Answer 29

Quetiapine

Question 30

Whats for lithiumrefractory patients, rapid cyclers, or mixed states.
It has some acute antimanic effects, but its long
term effectiveness is unclear.

Answer 30

Carbamazepine

Question 31

What’s often used for

manic episodes in treatment-resistant patients.

Answer 31

The combination of carbamazepine with lithium,

valproate, and antipsychotics

Question 32

During the first month of therapy, why do increase dose

Answer 32

Serum concentrations decrease because of autoinduction of metabolizing
enzymes, requiring a dose increase.

Question 33

What’s effective for the maintenance treatment of
bipolar I disorder in adults. It has both antidepressant and mood-stabilizing effects, and it may have augmenting
properties when combined with lithium or valproate.

Answer 33

Lamotigrine

Question 34

can I Combine lithium with typical antipsychotics

Answer 34

causes neurotoxicity