Bipolar Disorder Flashcards
Manic Episode criteria: Need how many?
3 or more, 4 if irritability is the only feature. 1 week OR hospitalization
Hypomanic episode criteria: Need how many and for how many days?
3 or more. 4 if irritability is the only feature. 4 consecutive days. Needs to be observable by others.
Catatonia as a specifier
Need 3 of: posturing, gmannerism, sterotypy, agitation not influenced by external stimuli. grimacing, echolalia, echopraxia.
Cyclothymic Disorder
2 years. Symptoms present at least half the time and patient has not been without symptoms for more than 2 months at a time.
Primary Mania vs Secondary Mania
Primary mania is early onset, no obvious medical cause, high family history of bipolar disorder, and good response to lithium. Mania secondary to meds will have a poor response to lithium.
Rapid cycling, what counts?
All mood including manic, hypomanic, AND depressed
How does lithium ultimately work?
Has effects on second messengers and gene expression. Slows down signal transduction in neurons.
Inhibits inositol monophosphatase.
Meds with bipolar depression indications
Symbyax, quetiapine, latuda. NO lamictal.
Latuda is only SGA that is not approved for
mania
Which antidepressant is least likely to switch?
wellbutrin
Lithium is least helpful in
mixed states. Instead use valproic acid, tegretol, geodon, abilify, or asenapine.
Lithium and end of pregnancy
Prior to delivery, decrease dose to half or stop temporarily. Neonatal toxicity is floppy baby syndrome (cyanosis, hypotonicity ) from exposure during labor. `
Valproate dosing
20 mg/kg to load, then start at 750. Target blood level is 90.
Symptoms of hepatotoxicity from depakote
Malaise, weakness, lethargy, facial edema, anorexia, vomiting. The LFTs aren’t super helpful . May see hyperammonemia.
Depakote causing pancreatic adverse effects
VPA-caused pancreatitis may occur. Can get hemorrhagic, quickly leading to death.
Depakote and PCOS
4-10% of pts on VPA get it within 1 year
Depakote and OCP
Depakote interacts with OCP to lower the level, making pregnancy more likely.
Tegretol and Asian Patients
You MUST get genetic testing for HLA B1502, as that is associated with SJS
Lamictal risk of SJS
1/1000 with rapid titration, 1/6000 with slow titration. Target dose is 200-400 mg. Risk increases beyond that.
What type of therapy is good for bipolar?
Social rhythm therapy
Lithium induced Nephrogenic DI
Lithium-induced nephrogenic diabetes insipidus is usually a self-limiting condition in which there is a down-regulation of channel aquaporin-2 in the luminal wall of the cell’s surface, leading to decreased urine osmolality and increased urine volume (polyuria). ADH levels are adequate or even high, but its action on the V2 receptor is defective. V1-receptor is located in the vascular smooth muscles and is involved in total peripheral resistance regulation.
Mechanism of action of depakote
Blocks GABA transaminase, increasing synaptic levels of GABA.
What is cyclothymic disorder?
Cyclothymic disorder requires over 2 years the presence of numerous periods of both hypomanic symptoms and depressive symptoms not meeting criteria for manic or hypomanic episodes or for major depressive disorder, with symptom-free periods no longer than 2 months.
What teratogenic effects does carbamazepine have on the fetus?
Craniofacial abnormalities.
Symptoms of lithium toxicity
cognitive slowing, slurred speech, poor memory, and drowsiness,
Risk factors for bipolar disorder
Attention-deficit/hyperactivity disorder (ADHD) and conduct disorders, aggression, and impulsivity have consistently been reported as clinical risk factors for later bipolar disorder in prospective studies
Carbamazepine and SIADH
SIADH is a recognized side effect of carbamazepine (CBZ) therapy, even with therapeutic doses. Elevated CBZ levels are more likely to manifest as slurred speech, double vision, ataxia, and somnolence.
Minimum period of time to taper and stop lithium in a maintenance patient?
2 weeks
Hypothyroidism worse in regular bipolar or rapid cycling?
Thyroid problems are more common in the complex forms of bipolar disorder (mixed states and rapid cycling) than in classic bipolar manic patients.
Which medication can LOWER the lithium level?
Acetazolamide
What is seen in patients with manic episodes secondary to medical condition?
They are generally older, and more irritable.
How many days needed for a hypomanic episode?
4 days
Why do teens quit lithium? What about adults?
Acne. Tremor.
What are females with bipolar more likely to have than males?
Females with bipolar disorder are likely to experience patterns of comorbidity different from those of males, such as higher lifetime rates of eating disorders. They also have a higher lifetime risk of developing alcohol use disorder as compared to males with bipolar disorder, as well as a greater likelihood of developing alcohol use disorder compared to females in the general population
What med can INCREASE the dose of depakote?
aspirin
Disinhibition in bipolar is a dysfunction of what part of the brain?
ventrolateral prefrontal cortext
Which mood stabilizer can cause cognitive impairment at usually therapeutic dosages?
topiramate
Atomoxetine and bipolar
caution as it can also cause manic switching
A diagnosis of substance/medication-induced bipolar and related disorder can be assigned if mood symptoms develop within what period after the substance intoxication or withdrawal?
1 month
Name bipolar brain anatomy parts impacted
orbitofrontal cortex
Ventrolateral prefrontal cortex: disinhibition