Bipolar Disorder Flashcards

1
Q

How is bipolar disorder categorized?

A

It is characterized by fluctuations in mood from an extremely sad or hopeless state to an abnormally elevated, overexcited or irritable mood called mania or hypomania (a milder form fo mania). Each mood episode represents a drastic change from an individual’s symptoms of both mania and depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is bipolar disorder classified?

A

Bipolar disorder is classified as bipolar I or bipolar II, which differ primarily by the severity of mania experienced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is cyclothymia?

A

Cyclothymia is a related disorder consisting of periods of hypomanic and depressive symptoms without meeting criteria for a major depressive, manic or hypomanic episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some possible complications of bipolar disorder?

A

Bipolar disorder can reduce quality of life or cause problems with relationships and employment. It can also lead to drug abuse, anxiety disorders and suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the definition of mania?

A

Abnormally elevated or irritable mood for at least a week (or any duration if hospitalization is needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of mania?

A
  • Inflated self-esteem
  • Needs less sleep
  • More talkative than normal
  • Jumping from topic to topic
  • Easily distracted
  • Increase in goal-directed activity
  • High-risk, pleasurable activities (e.g. buying sprees, sexual indiscretions, gambling)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you diagnose mania?

A

Exhibits > 3 symptoms (if mood is only irritable, exhibits > 4 symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe Bipolar I

A

At least one episode of mani, and usually, bouts of intense depression (a depresssive episode is not required for diagnosis). Mania is associated with at least one of the following: significant impairment in social/work functioning, psychosis/delusions or requires hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe Bipolar II

A

At least one episode of hypomania (lasting > 4 consecutive days) and at least one depressive episode (lasting > 2 weeks). Hypomania does not affect social/work functioning, does not causes psychosis nor require hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the definition of bipolar depression?

A

Predominant symptoms of depressive episode include feelings of sadness or depressed mood and/or loss of interest in previously enjoyed activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definition of psychosis?

A

Severe mental condition where there is a loss of contact with reality, involves abnormal thinking and perception (e.g. hallucinations and delusions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you diagnose bipolar disorder?

A

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria are used to diagnose bipolar disorders

*A toxicology screen should be done prior to starting treatment ot rule out drug-induced mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the goal of treatment of patients with bipolar disorder?

A

The goal of treatment is to stabilize the mood without inducing a depressing or manic state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which medications can treat both mania and depression without inducing either state?

A

The traditional mood stabilizers, such as lithium and antiepileptic drugs (valproate, lamotrigine and carbamazepine), treat both mania and depression without inducing either state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which medications can be used toe help stabilize the mood when mania occurs with psychosis?

A

Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When can antidepressants be used for the treatment of bipolar disorder?

A

Antidepressants can induce or exacerbate a manic episode when used as monotherapy, so they should only be used inc combination with a mood stabilizer

17
Q

How do you select a treatment for bipolar disorder?

A
  • The side effect profile of the drug
  • The patient’s medication history and first-degree relatives’ medication history; if the patient or a family member responded well to a drug, the same drug might be a reasonable option
  • The drug formulations available and cost
18
Q

What is the acute treatment for a manic episode?

A

First-line treatment is valproate, lithium or an antipsychotic. A combination of an antipsychotic + lithium or valproate is preferred for severe episodes

19
Q

What is the acute treatment of a depressive episode?

A

First-line treatment is lithium, but lamotrigine can be used as an alternative

20
Q

What are maintenance medications that can be used for bipolar disorder?

A

Lithium and valproate are preferred for maintenance monotherapy, but lamotrigine, carbamazepine and second-generation antipsychotics are alternatives. Antipsychotics or antidepressants may be added to lithium or valproate for maintenance therapy

21
Q

What is required with all antidepressants and with all antipsychotics?

A

MedGuides

22
Q

Why is treating bipolar disease in pregnancy complex?

A

Common mood stabilizers are teratogenic

23
Q

What can valproate exposure do in pregnancy?

A

Valproate exposure in pregnancy can increase the risk of fetal anomalies, including neural tube defects, fetal valproate syndrome and long-term adverse cognitive effects. Avoid in pregnancy, if possible, especially during the first trimester

24
Q

What can carbamazepine exposure do in pregnancy?

A

Carbamazepine exposure in pregnancy can cause fetal carbamazepine syndrome, which can result in facial abnormalities and other significant issues. Avoid in pregnancy, if possible, especially during the first trimester

25
Q

What can lithium exposure do in pregnancy?

A

Lithium exposure in pregnancy can cause an increase in congenital cardiac malformations and other abnormalities

26
Q

What is recommended for treatment of bipolar disorder in pregnancy?

A

During pregnancy, lamotrigine is a safer option relative to the other mood stabilizers. SGAs are safer choices than valproate, carbamazepine or lithium. Lurasidone has the most favorable safety profile in pregnancy, but its use is limited since it is only approved for bipolar depression

27
Q

What anticonvulsants are used for the treatment of bipolar disorder?

A

Lamotrigine, Valproate/Valproic Acid derivatives, Carbamazepine

28
Q

What generation of antipsychotics are preferred for the treatment of bipolar disorder?

A

The first-generation antipsychotics have a higher incidence of EPS than SGAs, so SGAs are preferred

29
Q

What second generation antipsychotics are used for bipolar disorder?

A

Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone, Lurasidone, Olanzapine/Fluoxetine

30
Q

What is the MOA of Lithium?

A

Lithium is proposed to work by influencing the reuptake of serotonin and/or norepinephrine or by moderating glutamate levels in the brain. Glutamate is the primary excitatory neurotransmitter, so high levels could cause mania

31
Q

What is a boxed warning of lithium?

A

Serum lithium levels should be monitored to avoid toxicity

32
Q

What are some warnings associated with Lithium?

A

Renal impairment, hyponatremia and dehydration (increase lithium toxicity), serotonin syndrome

33
Q

What are some side effects of Lithium within therapeutic range?

A

GI upset (nausea/diarrhea), cognitive effects, cogwheel rigidity, fine hand tremor, thirst, polyuria/polydipsia, weight gain, hypothyroidism, hypercalcemia, cardiac abnormalities, edema, anorexia, worsening psoriasis, blue-gray skin pigmentation, impotence

34
Q

What are some side effects of Lithium when in toxic levels?

A

> 1.5 mEq/L: ataxia, coarse hand tremor, vomiting, persistent diarrhea, confusion, sedation

> 2.5 mEq/L: CNS depression, arrhythmia, seizure, coma

35
Q

What are monitoring parameters of Lithium?

A

Serum lithium levels, renal function, thyroid function (TSH, FT4), electrolytes (calcium, potassium, sodium)

36
Q

What are some notes about Lithium?

A
  • Renally cleared; no CYP450 interactions

- Avoid in pregnancy; associated with cardiac malformations in first trimester; avoid in breastfeeding

37
Q

What are some drug interactions with Lithium?

A
  • Lithium levels increase with decreased salt intake, sodium loss, NSAIDs
  • Lithium levels decrease with increased salt intake, caffeine and theophylline
  • Increased risk of serotonin syndrome if lithium is taken with SSRIs, SNRIs, triptans, linezolid and other serotonergic drugs
  • Increased risk of neurotoxicity (e,g, ataxia, tremors, nausea) if lithium is taken with Verapamil, Diltiazem, Phenytoin and Carbamazepine
38
Q

What is the conversion between lithium formulations?

A

5 mL lithium citrate syrup = 8 mEq of lithium ion

8 mEq of lithium ion = 300 mg lithium carbonate tabs/caps

39
Q

What are key counseling points of Lithium?

A
  • Take with food or at end of meal to reduce nausea
  • Maintain consistent salt intake. Changes in salt intake can alter lithium levels in the body
  • Maintain adequate hydration with non-caffeinated fluids
  • Avoid dehydration which can increase lithium levels and side effects
  • Avoid in pregnancy/breastfeeding
  • Notify healthcare provider immediately for worsening nausea or diarrhea, slurred speech or confusion
  • Can impair alertness, use caution while driving or during other tasks requiring you to be alert