Bipolar Disorder Flashcards
epidemiology: BAD
M=F
mean onset 17-21
if first episode mania >50y then primary cause investigated
causes: BAD
genetic - first degree relative = 10% risk
concordance monozygotic twins 80% and dizygotc - 20%
environmental - life events, severe stressors, late spring and summer and psot-partum
neurochemical - excess dopamine, noradrenaline and serotonin
rx: BAD
mania
environment: low stimulus, ?hospital, ?detetntion
tx: antipsychotics, mood stabilisers, benxodiazepines/hypnotics
psychological: ECT
gold standard tx: BAD
lithium
reduces presynaptic dopamine
facilitates releace GABA
moitoring: lithium
- height/weight
- bloods - U+E, creatinine clearance, FBC< TFTs, calcium
- ECG
- pregnancy test
- check serum levels weekly initially until levels stabilised
- monitor serum levels 3 monthly
- check for SEs
- TFTs and renal fx 6 monthly
- monitor weight
moitoring: lithium
- height/weight
- bloods - U+E, creatinine clearance, FBC< TFTs, calcium
- ECG
- pregnancy test
- check serum levels weekly initially until levels stabilised
- monitor serum levels 3 monthly
- check for SEs
- TFTs and renal fx 6 monthly
- monitor weight
SE: lithium
GI upset
fine tremor
renal impairment
pluria/polydipsia
weight gain
oedema
hypothyroidism
hyperparathyroidism
hypercalcaemia
therapeutic level: lithium
0.5-1.0mmol/l
drug interactions: lithum
antipsychotics
carbamazepine
diuretics
idoine salts (increase hypothyrodiism)
NSAIDs
SSRIs (serotonin syndrome)
ACE/ARBs
theophyline
verapamil
metronidazole
tetracyclines
toxicity: lithium
> 1.5mmol/l
* blurred vision
* ataxia
* coarse tremor
* muscle weakness
* confusion
* slurred speech
* convulsions
* N+V
* ECG changes - bradycardia, heart block and AV node block
def: bipolar I
at least 1 manic or mixed episode
severe depression and mania
def: bipolar II
never been manic
at least 1 hypomanic episode
at least 1 major depressive episode
ix: BAD
- FBC
- U+E
- TFT
- LFT
- ESR
- serum/urine drug screen
- pregnancy test
signs: BAD
mod: irratibility, euphoria, lability
cognition: grandiosity, flight of ideas/racing thoughts, distractibility, poor concentration, confusion, lack of insight
behavious: rapid speech, hyperactivity, decreased sleep, hyper-sexuality, extravagance
psychotic symptoms: dellusions, hallucinations
tx: BAD
stop antidepressants
antipsychotics in mania
lithium 1st line
sodium valproate (better in depressive phases)
carbemazpeine and lamotrigine in rapid cycling
