Bipolar Disorder

Question 1

Bipolar 1 disorder

Answer 1

Pts has severe mania and usually bouts of intense depression

No doubt that person is manic

Question 2

Bipolar 2 disorder

Answer 2

Hypo mania and usually bouts of intense depression

Hypo mania does not affect social/work function usually

Question 3

What should be ruled out before diagnosing mania?

Answer 3

Illicit drug use

Question 4

Mania

Answer 4

Abnormally elevated or irritable mood for at least a week plus 3-4 other symptoms

Question 5

Other symptoms of mania

Answer 5

Inflated self-esteem
Sleeping less
Talkative 
Jumping from topics
Easily distracted 
Increase in goal directed activity 
High risk, pleasurable behavior (buying sprees, sex (cheating), gambling)

Question 6

Goals of drug treatment

Answer 6

Stabilize mood and prevent both manic and depression episodes

Question 7

Mood stabilizers role

Answer 7

Treat both mania and depression and do not induce either state

Question 8

Common mood stabilizers

Answer 8

Lithium
Valproate
Lamotrigine
Carbamazepine

Question 9

When would antipsychotics be used?

Answer 9

When manic pts experience psychosis

Some are used as mood stabilizers

Question 10

What antipsychotics are preferred in bipolar disorder?

Answer 10

Second (atypical) because bipolar pts are at incr risk for EPS with 1st gen antipsychotics

Question 11

Acute treatment of manic state

Answer 11

Valproate or lithium
Plus
Antipsychotic

Question 12

Acute treatment for bipolar depression

Answer 12

Lithium or lamotrigine

Lurasidone and olazapine/fluoxetine are also approved for bipolar depression

Question 13

Why are antidepressants generally not recommend?

Answer 13

They can induce a manic episode

Ok to use if pt is also on mood stabilizer

Question 14

Why is lamotrigine not used for acute mania?

Answer 14

Lamotrigine requires a slow titration when initiated due to incr risk of severe rash

Question 15

Mood stabilizer safest in pregnancy

Answer 15

Lamotrigine

2nd gen APs are also relatively safe

Lurasidone (Latuda) is also safe, but is only used for bipolar depression

Question 16

Carbamazepine formulation approved for bipolar

Answer 16

Equetro

Question 17

2nd gen APs used in bipolar disorder

Answer 17

Aripiprazole
Asenapine 
Cariprazine
Lurasidone
Olanzapine 
Quetiapine
Risperidone 
Ziprasidone

Question 18

Lithium brand

Answer 18

Lithobid

Question 19

Lithium initial dose

Answer 19

150-900 mg/day divided TID

Question 20

Lithium max dose

Answer 20

900-1800 mg/day TID-aid

ER dosed BID

Question 21

Lithium therapeutic range

Answer 21

0. 6-1.2 mEq/l

1. 5 for acute mania sometimes

Question 22

Lithium clearance

Answer 22

100% Renal

Question 23

Lithium side effects

Answer 23

GI EFFECTS 
Tremor 
Sedation
Weight gain
Cognitive effects
Cogwheel rigidity 
Polyuria/polydypsia
Hypothyroidism

Question 24

5 ml of lithium citrate solution =

Answer 24

8 eEq of lithium

Question 25

8 mEq lithium =

Answer 25

300 mg of lithium carb tab/cap

Question 26

These incr lithium levels

Answer 26

Decr salt intake
Ace inhibitors arbs
NSAIDs (Asa and sulindac are safer)

Question 27

These decr lithium levels

Answer 27

Incr salt intake
Caffeine
Theophylline

Question 28

Lithium has incr risk of serotonin syndrome with sertonergic drugs (t/f)

Answer 28

True

SSRIs SNRIs etc

Question 29

Lithium counseling

Answer 29

Drink plenty of water

Take with food or at the end of a meal to avoid nausea