Bipolar disorder

Question 1

What is bipolar disorder?

Answer 1

Bipolar disorder is a mental health condition that causes extreme mood swings.

Question 2

What are the symptoms of bipolar disorder?

Answer 2

The main symptoms of bipolar disorder are episodes of extreme highs and lows, which can last for several weeks.

Mania​.
Depression​.
Hypomania​.

Question 3

What is bipolar I?

Answer 3

At least one manic episode needed for diagnosis. Major depressive episodes are typical, but not needed for diagnosis.​

​Bipolar I affects men and women equally.​

Question 4

What is bipolar II?

Answer 4

Bipolar II disorder is characterised by one or more major depressive episodes and by at least one hypomanic episode, but no evidence of mania​.

Question 5

What are the treatment options?

Answer 5

Physiological Interventions​:

​Family intervention​.
Group intervention​.
Structured individual intervention​.

Pharmacological​:

​Antipsychotics​.
Benzodiazepines.​
Mood stabilisers​.
Antidepressants​.

Question 6

What is aripiprazole?

Answer 6

Aripiprazole is a dopamine D2 partial agonist with weak 5-HT1a partial agonism and 5-HT2A receptor antagonism.​

It is an atypical antipsychotic​

Question 7

What is olanzapine?

Answer 7

This is an atypical antipsychotic​.

Doses in first episode psychosis are generally lower​.

Question 8

What is haloperidol?

Answer 8

This is a typical antipsychotic​.

Question 9

What is rapid tranquillisation​?

Answer 9

Refers to the use of medication to calm highly agitated individuals experiencing mental disorder who have not responded to non-pharmacological approaches.

Question 10

What is quetiapine?

Answer 10

This is an atypical antipsychotic​.

Available as tablets and liquid​.

​Also available as long acting and short acting tablets (MR)​

Question 11

What is risperidone?

Answer 11

This is an atypical antipsychotic​.

Question 12

What is a mood stabiliser?

Answer 12

A mood stabiliser is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, such as bipolar disorder and the bipolar type of schizoaffective disorder.

Question 13

What are some examples of mood stabilisers?

Answer 13

Sodium Valproate​.
Lithium​.
Carbamazepine.​
Lamotrogine​.

Question 14

What are the types of sodium valporate available?

Answer 14

Epilim​.
Depakote​.
Pregnancy prevention programme​.

Question 15

What should the pharmacist consider when giving pregnancy prevention programme​?

Answer 15

Pharmacist must ensure whole packs are dispensed whenever possible​.

​All packs should have a warning or a sticker​.

Must discuss risks and ensure that patients have a patient guide​.

​Must check that patients are ware of need for contraception​.

Question 16

What clinical monitoring must be carried out for sodium valproate​?

Answer 16

Liver function tests​.

​Vitamin D supplementation​.

Question 17

What clinical monitoring must be carried out for lithium​?

Answer 17

Lithium level 5 days after first administration. ​

​5 days after each dose change​.

​Every 3 months​.

​U and E, TFT every 6 months​.

Levels if toxicity is suspected​.

Question 18

What are the side effects and interactions​ of lithium?

Answer 18

Side effects​:

​Metallic taste​.
Thirst​.
Tremor.​

Interactions​:

NSAIDS .
Ace inhibitors.
Low salt diet​.

Question 19

What is carbamazepine?

Answer 19

Licensed for prophylaxis of bipolar disorder unresponsive to Lithium​.

​Does not require any additional monitoring except manufacture suggest monitoring LFT and WBC​

Question 20

What is lamotrigine?

Answer 20

Licensed for use in epilepsy or bipolar disorder.

No therapeutic drug monitoring needed​.

Doses must be titrated gradually to reduce risk of Steven Johnson syndrome​.

Question 21

When should antidepressants be used?

Answer 21

SSRI​s are drugs of choice.

Used for short time - different to unipolar depression. ​

​Prescribed alongside mood stabilisers.

Question 22

How would you treat depression?

Answer 22

Use antidepressants for the shortest time possible​.

​Consider using a mood stabiliser in combination with an antipsychotic licensed for prevention of mania​.