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Bipolar Disorder Flashcards

1
Q

Bipolar one disorder

A

Mania with Major depressive episodes

includes anything where mania results in hospitalization

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2
Q

Bipolar two disorder

A

hypomania with major depressive episodes

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3
Q

Mixed episode in bipolar disorder

A

mania and depression all at the same time

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4
Q

rapid cycling in bipolar disorder

A

4 major depressive or manic episodes in a 12 month period

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5
Q

What is Bipolar disorder often misdiagnosed as?
Why?
What happens when it is misdiagnosed this way

A

Unipolar depression because patients often present with depression and manic episodes are not brought to the attention of the physician
Physician describes antidepressants which can swing patient into a manic episode

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6
Q

Diagnosis of a manic episode

A

At least one week with at least 3/7 symptoms
DIG FAST
Distractibility
Increased activity or psychomotor activity
Grandiosity- inflated self esteem
Flight of ideas
Activities that are dangerous, hypersexual, or goal directed
Sleep- decreased need (1-2 hours/ night)
Talkative or pressured speech

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7
Q

Diagnosis of Hypomania

A

same set of DIG FAST symptoms but alsting at least 4 days

but not severe enough for a marked change in social or functional impairment

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8
Q

Epidemiology

A

average age of onset is 21

first presents in females as depressive episode, males as manic episode

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9
Q

Etiology

A

Most genetic of all psychological disorders
stressful or exciting events can trigger an episode
getting off of the rhythm can also trigger an episode

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10
Q

What is suicide rate in untreated bipolar disorder

other issues in untreated

A

10-20%
higher rate of job loss
divorce, violence, incarceration, and STDs

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11
Q

Concurrent social functioning issues

A

Substance abuse- inc risk of suicide

many patients lack insight into their disease making it hard to tx

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12
Q

What is compliance like

A

50-75% dont maintain their drug regimen

90% relapse

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13
Q

What happens if TCA’s or SNRI’s are given to these patients

A

Mania or rapid cycling

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14
Q

Triggers for Bipolar Episodes

A

avoid triggers such as sleep deprivation, antidepressants without a mood stabilizer, alcohol

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15
Q

Role of ECT in bipolar management

A

Bilateral ECT is used for acute mania and acute depression.
indicated in drug resistant mania
Pregnancy

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16
Q

Role of psycho education in bipolar management

A

Important for pt to learn to recognize the signs early so that they can take preventative measures

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17
Q

Li

A

Lithium

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18
Q

Li MOA

A

Not well understood

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19
Q

Gold standard to tx bipolar disorder is

A

Li

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20
Q

Why is Li the gold standard in bipolar tx

A

stabilizes acute mania, prevents relapse of mania and depression
does more to prevent mania than prevent depression
decreases suicide rate

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21
Q

how does Li compare to other drugs for dealing with depression

A

Better than many other drugs for dealing with depression in bipolar disorder

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22
Q

What is the metabolism/ Pharmacokinetics of Li?

how is it handled in the body

A

Rapidly absorbed, not metabolized, no protein binding
steady state is reached in 5 days but takes 1-2 weeks to see full effects
Renal excretion

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23
Q

Does Li have psychotropic effects in pts who dont have bipolar disorder?

A

no psychotropic effects

24
Q

What should patients use while waiting for Li take effect

A

takes 1-2 weeks

should use adjunctive therapy

25
What are the AE of Li
``` Dose dependent tremor psoriasis/ rash weight gain acne hypothyroid GI discomfort (N/V/D, GI pain) ```
26
What renal or urinary complications can be caused by LI
reduces the ability to concentrate the urine causes interstitial fibrosis and gloerulosclerosis dose dependent DI polydipsia and polyuria
27
How should dif GI AE be handled
N/V and pain are caused by irritation of GI, this is early onset so take it with food or use sustained release or divided dose Diarrhea is caused by colon irritation from unabsorbed Li --> use liquid or immediate release dosage
28
What are the signs of acute Li intoxication? | How is it avoided?
Seizures, Arrhythmia GI, coordination issues, cognition issues, permanent neurologic impairments, kidney damage Maintain adequate Na and fluid intake
29
What drugs increase the level of Li
NSAIDs- interfere with PGE synthesis --> dec elimination ACE and ARB- RAAS Thiazide diuretics- inc Li reab in distal tubule b/c inc Na reab
30
What effect does GFR have on serum Li
as GFR dec serum Li increases
31
What is the role fluid and Na balance in Li serum concentration
Dehydration inc Na reab as does low Na --> both inc Li reab so inc Li levels Hyponatremia and dehydration lead to Li toxicity
32
CI for Li
Renal dysfunction Pregnancy- Cat D- Ebstein's anomaly cardiac dysfunction
33
Anticonvulsants used in the tx of Bipolar disorder
Valproate Carbamazepine/ Oxcarbazepine Lamotrigine
34
Valproate MOA
enhances GABA to break acute mania and manage mixed mania | Also affects Na channels
35
Indications for Valproate
Superior to Li in mixed mania and rapid cyclers | alternative to Li
36
AE for Valproate
``` weight gain PCOD hepatotoxicity neutropenia thrombocytopenia ```
37
CI for Valproate
pregnancy- causes neural tube defects and lowers IQ
38
What baseline tests should be done before giving someone Li
``` CBC- b/c may cause thrombocytopenia SCr and BUN to monitor renal function Thyroid function test- may cause hypothyroid Urinalysis- may cause polyuria Electrolytes ```
39
What blood tests should be monitored while taking Li
Li levels CBC SCr/ BUN urine TSH
40
what stage of bipolar disorder are higher therapeutic levels of Li required
during acute mania | remember Li has a narrow therapeutic index
41
Carbamazepine/Oxcarbazepine- indications
when Li and Valproate fail
42
Lamotrigine MO
blocks voltage gated Na channels to block excitatory glutamate and aspartate
43
How long does it take to achieve a therapeutic dose
2 months of titrating up
44
Why does it take so long to titrate to a therapeutic dose
AE include Steven's johnson syndrome (toxic necrotizing epidermolysis) and HA. Titrate up to avoid the rash
45
What is the black box warning on Lamotrigine
Steven's Johnson syndrome
46
what effect does valproate have on Lamotrigine levels
Valproate inc Lamotrigine levels
47
Lamotrigine indications
used with Li b/c better at managing the depression but is not effective for stabilizing or preventing mania
48
What drugs are used to treat acute agitations
atypical antipsychotics BZD- clonazepam, lorazepam Antidepressants- SSRIs, venlafaxine, buproprion
49
What is the role of atypical antipsychotics in bipolar disorder
fast acting monotx to be used with Li or valproate the pt may have to be on these long term for mood stabilization indicated over BZDs in psychosis and acute mania
50
what is the role of BZDs in tx bipolar disorder
used to dec agitation and insomnia- they do not tx the dz
51
What is role of antidepressants in tx of bipolar disorder
use cautiosly and make sure use with a mood stabilizer otherwise it can throw them into mania. careful with pts with a history of going into acute mania or rapid cyclers when given an antidepressant
52
what is the theory explains why anticonvulsants work
Kindling theory
53
DOC for depression phase of bipolar disorder
Li and Lamotrigine
54
DOC for mixed and rapid cyclers
Valproate and Carbamazepine
55
DOC for pregnancy in bipolar disorder
Antipsychotics | ECT

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