Bipolar disorder and mania Flashcards
What are the symptoms of bipolar disorder and mania?
Mania
- High energy
- Overly ambitious plans
- Risky, harmful acts
- Easily distracted
- Hallucinations, delusions
Depression: low mood
What is the treatment for bipolar disorder and mania?
Acute episodes + maintenance
- Lithium
- Valproate
- Antipsychotics (Quetiapine, Risperidone (for acute only), Olanzapine)
Antidepressants CI in acute manic episodes - elevates mood, worsening mania
What is the indication for lithium?
prescribe by BRAND
- Bipolar disorder
- Recurrent depression
- Aggressive + self harm
What is the target therapeutic index of lithium?
0.4-1MMOL
- 12H after dose
- Regular monitoring: 3-6M
What are the signs of lithium toxicity?
GREEN
GI effect: V + D
Renal: polyuria
Eyes: blurred vision
Extrapyramidal symptoms (tremor)
Nervous system (confusion, drowsy)
- Counselling: adequate fluids, avoid diet changes that affect sodium
What increases the risk of lithium toxicity?
Hyponatraemia
Renal impairment
Low fluid intake
- Caution: concomitant diuretics, intercurrent illness
- CI: low sodium diet, dehydration
- Monitor: electrolytes
What are the side effects of lithium?
Hypothyroidism
Nephrotoxicity
QT prolongation
Benign intracranial hypertension
- Counsel: Report persistent headaches + visual disturbances
Lower seizure threshold
- Monitor: epilepsy
Can you take lithium when pregnant?
Teratogenic
- Child bearing women: effective contraception
- Also present in breast milk + cause toxicity in infant
What are the interactions of lithium?
- Diuretics (Hyponatraemia) → INC lithium levels = toxicity
- Nephrotoxic drugs (RED renal excretion) → INC lithium levels = toxicity
- Effervescent analgesics (paracetamol, sodium containing antacids) → RED lithium levels = therapeutic failure
- Serotonergic drugs (Antidepressants, methadone, tramadol, St John’s Wort, sumatriptan) → Serotonin syndrome
- Drugs that prolong QT interval (Antipsychotics, citalopram + escitalopram, macrolides, methadone) → arrhythmias
- Drugs that cause hypokalaemia → INC risk of torsade de pointes
- Antipsychotics, TCA antidepressant → INC neurotoxicity