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Psych AM > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

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1
Q

What is bipolar?

A

2+ episodes f depression and mania/hypomania

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2
Q

When does bipolar normally present?

A

Late teens/early adulthood

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3
Q

What are the features of bipolar?

A

Depressed phase

Manic phase

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4
Q

What are the features of the depressed phase?

A 
Depressed mood
Energy decreased 
Anhedonia
Death thoughts
Sleep change
Worthlessness/guilt
Appetite change
Mentation decreased 
Psychomotor retardation
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5
Q

What are the features f the manic phase of bipolar?

A 
Distractability
Irritability
Grandiosity
Flight os ideas
Appetite secreased
Sleep decreased
Talkative
Elevated mood
Regular activities disrupted
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6
Q

How is bipolar diagnosed?

A

Depressed episode with previous manic or hypomanic episode

Manic episode with previous depressed episode

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7
Q

What is the management of bipolar in primary care?

A

Antipsychotis- olanzapine, risiperidone, quetiapine, aripriprazole
Psychological interventions

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8
Q

What is the management of bipolar in secondary care?

A

Mood stabilisers- lithium, carbamazepine, valproate
Antipsychotics
Psychological interventions
ECT, deep brain stimulation

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9
Q

What is the management of mania in bipolar?

A

Acute mania= carbamazepine
Consider stopping antidepressant if prescribed
Consider antipsychotic

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10
Q

What is the management of depression in bipolar?

A

FLuoxetine= antidepressant of choice

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11
Q

What are some mod stabilisers?

A

Lithium
Valproate
Carbamazepine

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12
Q

What is the most effective mood stabiliser?

A

Lithium

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13
Q

What should be done before prescribing lithium?

A

Baseline U&Es, TFTs and pregnancy test

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14
Q

What s the target level of lithium and when should it be tested?

A

0.6-1.2 at 3 months

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15
Q

What are some side effects of lithium?

A 
GI distress
Thyroid avnoralities
HAir loss
Acne
Polyria/polydipsia
Toxicity
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16
Q

What is the benefit of valproic acid?

A

Not as effective as lithium but better tolerated

17
Q

What should be done pre-prescribing valproic acid?

A

FBC, LFTs and pregnancy test

18
Q

What is the target level of valproate?

A

50-125

19
Q

What are some side effects of valproate?

A

Thrombocytopenia and platelet dysfunction
Tremor
Weight gain
Sedation

20
Q

What is carbamazepine used for?

A

1st line for acute mania and mania prophylaxis

Good for rapid cyclers

21
Q

What should be done pre-prescribing carbamazepine?

A

FBC, LFTs and ECG

22
Q

What is the target level of carbamazepine?

A

4-12

23
Q

What is a big downside to carbamazepine?

A

Lots of drug interactions contraception, warfarin, other psychoactive

24
Q

What are the features of lithium toxicity?

A 
Mild= N&V, tremor, hyperreflexia, agitation, weakness, polyuria, fasciculations 
Mod= Stupor, rigidity, hypertonic, hypotension
Severe= myoclonus, seizure, coma
25
Q

What is the management of lithium toxicity?

A

IV fluids

Consider bowel irrigation and dialysis

Psych AM (14 decks)

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