Bipolar Disorder

Question 1

What is meant by bipolar disorder

Answer 1

Extreme fluctuation between manic phases (overactive and excitability) and depressive phases (reclusive and lethargic)

Question 2

What is the acute and prophylaxis treatment of bipolar disorder

Answer 2

Acute:
Benzodiazepam
Antipsychotic drugs (quetiapine, olanazpine or risperidone)
Add lithium or sodium valproate

Prophylaxis:
Carbamazepine
Sodium valproate
Lithium

Question 3

What is the therapeutic range of lithium

Answer 3

0.4-1mmol/l

Question 4

What is an acute episode range of lithium

Answer 4

0.8-1mmol/l

Question 5

How long after a dose of lithium

Answer 5

After 12 hrs after a dose
Then
Weekly until stable, then
3 monthly for 1 year then
Every 6 months

Question 6

What are the symptoms of toxicity in lithium

Answer 6

Renal impairment- incontinence
Extrapyramidal side effects- tremors
Visual disturbances- blurred vision
Nervous system disorder- confusion and restlessness
GI disorder- diarrhoea and vomiting

Sick and tremor

Question 7

What are the side effects of lithium

Answer 7

Thyroid disorder
Nephrotoxicity
Rhabdomyolysis
QT prolongation
Benign intercranial hypertension (spotted by headaches)
1st trimester= teratogenic

Question 8

What’s are the interactions of lithium

Answer 8

Hyponatraemia increases the risk of toxicity- diuretics
Salt imbalances
Serotonin syndrome like ssris and tramadol
Extrapyramidial side effects antiemetics and antipsychotic
QT prolongation macrolides,rl-ccb, nsaids
Really cleared drugs (increased risk of toxicity)
Reduced seizure threshold
Hypokalaemia