bipolar disorder

Question 1

what is the aim of antimanic drugs in bipolar disorder

Answer 1

manage acute episodes of mania or hypomania and to prevent their recurrence

Question 2

when might an antidepressant drug be needed in bipolar disorder

Answer 2

if the patient has coexisting bipolar depression

Question 3

which bipolar patients should avoid antidepressants

Answer 3

• rapid-cycling bipolar disorder (they experience many episodes of illness a year)
• a recent history of mania or hypomania
• rapid mood fluctuations

Question 4

when would you consider stopping antidepressants in a bipolar patient

Answer 4

if mania or hypomania develops

Question 5

what are the first-line antipsychotics used to manage mania and hypomania

name the 4 first-line antipsychotics

Answer 5

• drugs (such as haloperidol, olanzapine, quetiapine, and risperidone) are used in the treatment of acute episodes of mania or hypomania
• if response inadequate, add lithium or valproate (if lithium not tolerated)

Question 6

when can you use lithium/valproate with an additional antipsychotic for bipolar

Answer 6

• if there is no improvement despite optimising the dose of lithium or valproate, an antipsychotic drug can be added to treat the acute episode of mania or hypomania
• lithium/valproate can be used together in the initial treatment of severe acute episodes of mania

Question 7

what is Asenapine used for in bipolar

Answer 7

moderate to severe manic episodes associated with bipolar disorder

Question 8

what is Olanzapine used for in bipolar

Answer 8

the long-term management of bipolar disorder to prevent recurrence of manic episodes in patients who respond to olanzapine therapy

Question 9

describe how you stop antipsychotic drugs

Answer 9

the dose should be reduced gradually over at least 4 weeks to minimise the risk of recurrence

Question 10

what is the use of benzodiazepines (e.g lorazepam) in bipolar

why should they NOT be used long-term

Answer 10

• the initial stages of treatment for behavioural disturbance or agitation
• Benzodiazepines should not be used for long periods because of the risk of dependence.

Question 11

how long does it take for the full effect of lithium to be seen in patients taking it for prophylaxis to prevent mania/hypomania episodes

Answer 11

the full prophylactic effect of lithium may not occur for six to twelve months after the initiation of therapy

Question 12

name the 3 drugs used in the long-term management of bipolar to prevent recurrence of acute episodes

Answer 12

• olanzapine
• lithium
• sodium valproate (if lithium not tolerate/contraindicated. or can be added to lithium is lithium alone not effective)

Question 13

what is the use of carbamazepine in bipolar

Answer 13

the long-term management of bipolar disorder, to prevent recurrence of acute episodes in patients unresponsive to lithium therapy

Question 14

what is the monitoring for all antipsychotics

Answer 14

• monitor prolactin concentration at the start of therapy, at 6 months, and then yearly. this is because a common side effect is hyperprolactinemia (increased prolactin levels)

Question 15

what monitoring should occur when antipsychotics are given in children

Answer 15

• Regular clinical monitoring of endocrine function
• measuring weight and height,
• assessing sexual maturation
• monitoring menstrual function.

Question 16

how long should patients be monitored for after stopping antipsychotics

Answer 16

Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse

• note there is a high risk of relapse if medication is stopped after 1–2 years*

Question 17

why should all patients taking antipsychotics avoid direct sunlight

Answer 17

photosensitisation may occur with higher dosage

Question 18

name some common side effects of all antipsychotics

Answer 18

• Agitation
• hyperprolactinemia (increased prolactin levels)
• amenorrhoea (period stops)
• arrhythmias
• constipation
• erectile dysfunction
• galactorrhoea (milky secretion from breasts)