bipolar disorder and mania

Question 1

Antidepressant may also be required for treatment of coexisting bipolar depression, but avoid in pt with (3)

Answer 1

rapid cycling bipolar disorder, recent history mania or hypomania, or rapid mood fluctuations

Question 2

Consider stopping antidepressant drug if patient develops (2)

Answer 2

mania or hypomania

Question 3

4 antipsychotic drugs used in treatment of acute episodes of mania or hypomania

HORQ

Answer 3

Haloperidol, olanzapine, quetiapine, risperidone

Question 4

If response to antipsychotic drugs in treatment of acute episodes of mania or hypomania is inadequate, can add (2)

Answer 4

lithium or valproate

Question 5

In patients already taking prophylactic treatment with lithium or valproate, if there is no improvement despite optimising dose of lithium or valproate, you can add….. to treat the acute episode of mania or hypomania

Answer 5

an antipsychotic drug
E.g. Haloperidol, olanzapine, quetiapine, risperidone

Question 6

An antipsychotic drug may also be used concomitantly with lithium or valproate in initial treatment of

Answer 6

severe acute episodes of mania

Question 7

asenapine - what is it and what is it licensed for

Answer 7

2nd Gen antipsychotic drug licenced for treatment of moderate to severe manic episodes associated with bipolar disorder

Question 8

this antipsychotic …… can be used for long term management of bipolar disorder and is licenced for prevention of recurrence in patients whose manic episodes have responded to it

Answer 8

Olanzapine

Question 9

When discontinuing antipsychotics the dose should be reduced gradually over at least ….. weeks to minimise risk of recurrence

Answer 9

4

Question 10

BZDPNs May be helpful in initial stages of treatment for …..

Answer 10

behavioural disturbance or agitation
Do not use for long periods because of risk of dependence

Question 11

Lithium salts (carbonate or citrate) used for treatment of ….

Answer 11

Acute episodes of mania or hypomania in bipolar disorder
Also used for long term management of bipolar disorder to prevent recurrence of acute episodes

Question 12

Decision to give prophylactic lithium must be based on careful consideration of

Answer 12

likelihood of recurrence in individual patient and the benefit of treatment weighed against risks

Question 13

The full prophylactic effect of lithium may not occur for how long

Answer 13

6 to 12 months after initiation of therapy

Question 14

When is valproate indicated (2)

Answer 14

Treatment of manic episodes associated with bipolar disorder if lithium is not tolerated or contraindicated
Also used for long term management of bipolar disorder to prevent recurrence of acute attacks, in combination with lithium if treatment with lithium alone is ineffective, or as monotherapy of lithium not tolerated or contraindicated

Question 15

carbamazepine role in bipolar disorder

Answer 15

Licence for long term management of bipolar disorder, to prevent recurrence of acute episodes in patients unresponsive to lithium therapy

Question 16

Summarise the 4 options that are given to pt after acute episode has resolves for long term management to prevent relapses

Answer 16

• continue current treatment for mania
• start long term treatment with lithium to prevent relapses
• if lithium ineffective, add valproate
• if lithium poorly tolerated, consider valproate alone or olanzapine

Question 17

which antipsychotic drug can be used in long term management to prevent relapses if lithium is poorly tolerated

Answer 17

olanzapine

Question 18

if mania develops, should you abruptly stop antidepressant

Answer 18

taper AD med of specialist advice

Question 19

can they drive during acute illness

Answer 19

no stop driving

Question 20

summarise the treatment of mania

Answer 20

• trial of oral antipsychotic - haloperidol, olanzapine, quetiapine, risperidone
• if one not tolerated or not effective, try a second from the 4 above
• if 2nd not effective, can add lithium or SV if lithium not suitable

Question 21

for the treatment of depression, what are the 4 options

Answer 21

• quetiapine
• fluoextine + olanzapine
• olanzapine
• lamotrigine

FO QOL

Question 22

how long is a depressive episode

Answer 22

at least 2 weeks

Question 23

how long for it to be classed as manic episode

Answer 23

at least 1 week

Question 24

how long for it to be classed as hypomanic episode

Answer 24

at least 4 days

Question 25

true or false - in hypomanic episode, there is no psychotic features

Answer 25

true

Question 26

what is rapid cycling bipolar disorder

Answer 26

experience of at least four depressive, manic, hypomanic, or mixed episodes within a 12-month period.