Bipolar Disorder

Question 1

Bipolar disorder characteristics

Answer 1

Fluctuations in mood from extremely sad or hopeless to abnormally elevated, over excited, or irritable mood

Question 2

Difference between bipolar I and II

Answer 2

Bipolar I: At least one episode of mania +/- depression

Bipolar II: at least one episode of hypomania and one depressive episode

Question 3

Mania symptoms, definition, diagnosis

Answer 3

Diagnosis: 3 or more symptoms
Symptoms: inflated self-esteem, needs less sleep, more talkative than normal, jumping from topics, easily distracted, increase in goal-directed activity, high-risk, pleasurable activities
Definition: abnormally elevated or irritable mood for at least a week

Question 4

What is the goal of treatment for bipolar disorder?

Answer 4

Stabilize the mood without causing a depressive or manic episode

Question 5

What medications are used for bipolar disorder?

Answer 5

Lithium, valproate, lamotrigine, and carbamazepine

Second generation antipsychotics

Question 6

What is used for acute treatment of manic episodes

Answer 6

Valproate, lithium, or antipsychotic

Question 7

What is used for acute treatment of depressive episodes

Answer 7

Lithium DOC or lamotrigine

Question 8

What is used for maintenance of bipolar disorder

Answer 8

Lithium and valproate – preferred monotherapy

Alternatives include lamotrigine, carbamazepine, and second gen antipsychotics

Question 9

What medications are used in pregnant women with bipolar disorder?

Answer 9

Lamotrigine is safest option
Lurasidone has most favorable safety profile but is only approved for bipolar depression
Do NOT use valproate, carbamazepine, or lithium

Question 10

Lithium therapeutic range

Answer 10

0.6-1.2 mEq/L (trough)

Question 11

Lithium warnings, SE, toxicity, monitoring

Answer 11

Warnings: serotonin syndrome
SE: GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, weight gain, hypothyroidism
Toxicity > 1.5 mEq/L trough: ataxia, coarse hand tremor, vomiting
Toxicity > 2.5 mEq/L trough: CNS depression, arrhythmia, seizure, coma
Monitoring: Lithium levels, renal function, thyroid function

Question 12

5mL lighium citrate syrup = ___ mEq lithium ion = 300 mg lithium carbonate tabs/caps

Answer 12

8

Question 13

Key counseling points for lithium

Answer 13

Take with food
Maintain consistent salt intake – can affect lithium levels
Avoid dehydration
Avoid in pregnancy