Bipolar Disorder Flashcards
Bipolar disorder is depression mixed with episodes of ___
Mania
Symptoms of a manic episode include
Increased irritability and increased energy for at least 1 week (or any time if hospitalized) as well as a decreased need for sleep
True or False: mental status exams are unable to differentiate between unipolar and bipolar depression
True. Family history and being < 25 years old is needed to be able to diagnose bipolar depression
True or False: suicide rate in bipolar depression is half of that in unipolar depression
False. It is double
True or False: the severity of a manic episode in Bipolar 1 disorder is greater than in a patient with Bipolar 2 disorder
True
True or False: patients with bipolar depression spend less time in a depressed state than in a manic state
False. More time is spent in a depressed state
5HT and DA have a(n) ___ relationship
Direct. Agonism of serotonin receptors inhibits dopamine release. The inhibition of serotonin receptors increases dopamine release
An excess of dopamine can lead to ___
Mania
A deficit of dopamine can lead to ___
Depression
There is a 30% prevalence of depression in ___ disease due to deficits of dopamine
Parkinson’s
Bipolar disorder is associated with ___ activity in the amygdala, ___ activity in the hippocampus, and ___ activity in the prefrontal cortex
Increased
Decreased
Decreased
These 3 medications are used to treat acute and chronic depression + acute and chronic mania
Lithium
Quetiapine
Olanzapine
These 5 medications are used to treat only acute and chronic mania
Risperidone Aripiprazole Ziprasidone Divalproex (valproic acid) Carbamazepine
This medication only treats acute depression
Lurasidone
This medication only treats chronic depression
Lamotrigine
This medication is the “most typical atypical”
Risperidone
What is the dosing and target level of Lithium?
Dosing: 600-900mg/day
Target level: 0.6-1.2mEq/L (1.2-1.5mEq/L in severe mania)
These medications increase lithium concentrations
Thiazides
These medications decrease lithium concentrations
Caffeine
Adverse effects of lithium
Polyuria, increased thirst, renal impairment, hypercalcemia, hypothyroidism, fine motor tremor
This adverse effect of lithium may occur during the first 6 months or may even take years to develop
Hypothyroidism
At steady state, a supplemental 300mg dose of lithium will increase lithium concentration by ___ mEq/L
0.2
This antipsychotic is associated with teratogenic effects and an increase in GABA
Valproic acid
What are common adverse effects of valproic acid
Homer Simpson - Alopecia, weight gain, hepatic impairment
Valproic acid dosing
Initial: 500-1000mg in 1 to 2 divided doses
Max of 60mg/kg
Most formulations of valproic acid are given BID except for:
Divalproex ER. It is dosed QD and is only 80% bioavailable. It requires a 20% dose increased when switching from other formulations
Which medication, used for bipolar disorder, is an “auto-inducer” for CYP3A4
Carbamazepine. It will reduce its own drug concentration over time
What is the dose and target drug level for carbamazepine?
200-600mg/day in divided doses
4-12mcg/mL
What is a common side effect for carbamazepine?
Rash
What two medications are used off-label for the treatment of bipolar disorder?
Oxcarbazepine and topiramate
What medication is used for “maintenance” treatment of bipolar disorder
Lamotrigine
What is the initial dose of lamotrigine? Changes are made to that dose in the presence of what other medications?
25mg QD
If taking VPA - 25mg QoD
If taking carbamazepine or phenytoin - 25mg BID
A rare but serious side effect of lamotrigine is ___
Stevens-Johnson Syndrome
___ is the active metabolite of risperidone
Paliperidone
What are common side effects of quetiapine?
Sedation and weight gain
This medication, used for acute mania or mixed episodes, should be taken with a meal > 500 calories
Ziprasidone. This is done to increase absorption
What medication, used for bipolar depression, should be administered with a meal > 350 calories and needs to be dose adjusted in hepatic impairment
Lurasidone
Capiprazine takes ___ to see an effect (whether good or bad) from a dose change
Several weeks
___ decrease the concentration of lamotrigine
Hormones (oral contraceptives)
A common side effect of lurasidone is ___
Akathisia (restlessness)
