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bipolar disorder Flashcards

1
Q

what is bipolar disorder?

A

lifelong, cyclical mood disorder
recurrent fluctuations in mood, energy & behaviour
mania & depressive

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2
Q

what can induce bipolar disorder?

A

treatment with antidepressants: few days to 2 weeks, increase NE/DA transmission

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3
Q

medical conditions inducing mania?

A

CNS disorders (brain tumor, stroked, head injuries)
CNS injfections (encephalitis, sepsis)
electrolyte/metabolic abnormalities
endocrine/hormonal dysregulation (hypothyroidism, hyperthyroidism)
vitamins & nutritional deficiencies

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4
Q

what medications can induce mania?

A

theophylline, caffeine
pseudoephedrine
st john’s wort
drug abuse: alcohol
drug withdrawal
antidepressants
DA augmenting agents
NE augmenting agents
thyroid hormone (levothyroxine)
steorids

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5
Q

what are the clinical presentation?

A

DIG FAST
distractability
irresponsible
grandious
flight of ideas
activities increased
sleep decreased
talkaltives

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6
Q

what is important to identify during hx taking?

A

hx of mania/hypomania
sucidal/homicidal ideations & risks

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7
Q

what lab test do you need to do before treatment?

A

FBC
TFT
renal panel
liver panel
ECG
FBG, lipids
pregnancy
HLA-B*1502 before starting carbamezepine

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8
Q

what is the goal of treatment?

A

reduce frequency, duration and severity of mood episodes
prevent suicide
maximise adherence with therapy
minimise side effects

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9
Q

what are the non-pharmacological approach for bipolar?

A

recognise early signs & symptoms
psychotherapy
stress reduction therapies
sleep hygiene

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10
Q

how is benzodiazepine use?

A

short term, PRN
onset within hours
taper off when condition improved & mood stabilizer optimized

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11
Q

which mood stablizier have the strongest evidence for suicide reduction?

A

lithium

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12
Q

what mood stabiliser can be use for mania?

A

antipsychotic: aripiprazole, olanzapine, quetapine, risperidone, haloperidol
lithium: 1st line for maintenance & relapse/suicide prevention
valproate (least prefered)

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13
Q

which mood stabiliser to be used for depression?

A

lithium: 1st line for maintenance & relapse/suicide prevention
quetapine, olanzapine + fluoxetine, lurasidone, cariprazone
lamotrigine

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14
Q

what is the MOA for lithium?

A

decrease 5HT & DA reuptake

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15
Q

what should be monitored when on lithium?

A

TFT, eletrolyte, calcium & renal function, urinalysis, FBC, ECG, pregnancy
serum lithium level: target steady dose in 5 days
acute mania: 0.8-1.0 mEg/L
maintenance: 0.6-1.0 mEg/L

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16
Q

what are the side effects for lithium?

A

fine coarse tremors
hypothyroidism
polyuria
ECG changes
weight gain, nausea, cognitive impairment, DM insipidius

17
Q

what is the MOA for sodium valproate?

A

increase GABA levels

18
Q

what should be monitored for sodium valproate?

A

LFTs, pregnancy
serum valproate: target 50-125mcg/mL

19
Q

adverse effects for sodium valproate

A

hepatotoxicity in child
rash, SJS/TEN
decrease PLT, pancreatitis
increase weight

20
Q

what to take note for sodium valproate?

A

cannot give to pregnant women
cannot give together with lamotrigine –> increase risk of SJS/TEN

21
Q

side effects of carbamazepine?

A

decrease Na, WBC
rash, SJS, TEN

22
Q

what to take note for carbamezepine?

A

should not give together with clozapine, increase risk of agranulocytosis

23
Q

what increases the risk of lithium toxicity?

A

STAND UP
sodium depletion
thiazide
ACEi/ARB
NSAIDs
dehydration

24
Q

clearance of lithium?

A

100% renal, not affected by liver

25
Q

which mood stabilizer should be administered without food?

A

lithium & valproate
food slow down absorption

26
Q

when is blood sample taken for lithium TDM?

A

sample 12hrs after prev dose
take 5-7 days after, q2w till stabilize, q3 months for 1 yr, q3-6mths

27
Q

when should blood sample be taken for valproate?

A

trough sample
not routinely taken, unless signs of toxicity/non-adherence

28
Q

when should carbamazepine blood sample be taken?

A

after 4wks, 3-5days later, q6month for 1 yr thn annually

29
Q

how long should mood stabilizer be given?

A

2-4 weeks
if no response, augment or switch to SGA

30
Q

what to take note for ECT?

A

lithium, anticonvulsants & benzodiazepeines need to be stop 12hrs before

31
Q

what should be monitored for when on carbamezepine?

A

FBC, LFT
serum lvl, target 4-12 mcg/mL

32
Q

which is a CYP inducer?

A

carbamezepine

33
Q

how to manage bpd in pregnancy?

A

avoid valproate
ECT is severe

34
Q

which mood stabilizer for renal impairment?

A

valproate

35
Q

which mood stabilizer for liver impairment?

A

lithium

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