Bipolar Disorder Flashcards
Bipolar 1 disorder
Pts has severe mania and usually bouts of intense depression
No doubt that person is manic
Bipolar 2 disorder
Hypo mania and usually bouts of intense depression
Hypo mania does not affect social/work function usually
What should be ruled out before diagnosing mania?
Illicit drug use
Mania
Abnormally elevated or irritable mood for at least a week plus 3-4 other symptoms
Other symptoms of mania
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)
Goals of drug treatment
Stabilize mood and prevent both manic and depression episodes
Mood stabilizers role
Treat both mania and depression and do not induce either state
Common mood stabilizers
Lithium
Valproate
Lamotrigine
Carbamazepine
When would antipsychotics be used?
When manic pts experience psychosis
Some are used as mood stabilizers
What antipsychotics are preferred in bipolar disorder?
Second (atypical) because bipolar pts are at incr risk for EPS with 1st gen antipsychotics
Acute treatment of manic state
Valproate or lithium
Plus
Antipsychotic
Acute treatment for bipolar depression
Lithium or lamotrigine
Lurasidone and olazapine/fluoxetine are also approved for bipolar depression
Why are antidepressants generally not recommend?
They can induce a manic episode
Ok to use if pt is also on mood stabilizer
Why is lamotrigine not used for acute mania?
Lamotrigine requires a slow titration when initiated due to incr risk of severe rash
Mood stabilizer safest in pregnancy
Lamotrigine
2nd gen APs are also relatively safe
Lurasidone (Latuda) is also safe, but is only used for bipolar depression
Carbamazepine formulation approved for bipolar
Equetro
2nd gen APs used in bipolar disorder
Aripiprazole Asenapine Cariprazine Lurasidone Olanzapine Quetiapine Risperidone Ziprasidone
Lithium brand
Lithobid
Lithium initial dose
150-900 mg/day divided TID
Lithium max dose
900-1800 mg/day TID-aid
ER dosed BID
Lithium therapeutic range
- 6-1.2 mEq/l
1. 5 for acute mania sometimes
Lithium clearance
100% Renal
Lithium side effects
GI EFFECTS Tremor Sedation Weight gain Cognitive effects Cogwheel rigidity Polyuria/polydypsia Hypothyroidism
5 ml of lithium citrate solution =
8 eEq of lithium
