bipolar disorder and mania Flashcards
Antidepressant may also be required for treatment of coexisting bipolar depression, but avoid in pt with (3)
rapid cycling bipolar disorder, recent history mania or hypomania, or rapid mood fluctuations
Consider stopping antidepressant drug if patient develops (2)
mania or hypomania
4 antipsychotic drugs used in treatment of acute episodes of mania or hypomania
HORQ
Haloperidol, olanzapine, quetiapine, risperidone
If response to antipsychotic drugs in treatment of acute episodes of mania or hypomania is inadequate, can add (2)
lithium or valproate
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
an antipsychotic drug
E.g. Haloperidol, olanzapine, quetiapine, risperidone
An antipsychotic drug may also be used concomitantly with lithium or valproate in initial treatment of
severe acute episodes of mania
asenapine - what is it and what is it licensed for
2nd Gen antipsychotic drug licenced for treatment of moderate to severe manic episodes associated with bipolar disorder
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
Olanzapine
When discontinuing antipsychotics the dose should be reduced gradually over at least ….. weeks to minimise risk of recurrence
4
BZDPNs May be helpful in initial stages of treatment for …..
behavioural disturbance or agitation
Do not use for long periods because of risk of dependence
Lithium salts (carbonate or citrate) used for treatment of ….
Acute episodes of mania or hypomania in bipolar disorder
Also used for long term management of bipolar disorder to prevent recurrence of acute episodes
Decision to give prophylactic lithium must be based on careful consideration of
likelihood of recurrence in individual patient and the benefit of treatment weighed against risks
The full prophylactic effect of lithium may not occur for how long
6 to 12 months after initiation of therapy
When is valproate indicated (2)
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
carbamazepine role in bipolar disorder
Licence for long term management of bipolar disorder, to prevent recurrence of acute episodes in patients unresponsive to lithium therapy
Summarise the 4 options that are given to pt after acute episode has resolves for long term management to prevent relapses
- 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
which antipsychotic drug can be used in long term management to prevent relapses if lithium is poorly tolerated
olanzapine
if mania develops, should you abruptly stop antidepressant
taper AD med of specialist advice
can they drive during acute illness
no stop driving
summarise the treatment of mania
- 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
for the treatment of depression, what are the 4 options
- quetiapine
- fluoextine + olanzapine
- olanzapine
- lamotrigine
FO QOL
how long is a depressive episode
at least 2 weeks
how long for it to be classed as manic episode
at least 1 week
how long for it to be classed as hypomanic episode
at least 4 days
true or false - in hypomanic episode, there is no psychotic features
true
what is rapid cycling bipolar disorder
experience of at least four depressive, manic, hypomanic, or mixed episodes within a 12-month period.