Bipolar disorder and mania Flashcards

1
Q

What are the symptoms of bipolar disorder and mania?

A

Mania
- High energy
- Overly ambitious plans
- Risky, harmful acts
- Easily distracted
- Hallucinations, delusions

Depression: low mood

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2
Q

What is the treatment for bipolar disorder and mania?

A

Acute episodes + maintenance

  • Lithium
  • Valproate
  • Antipsychotics (Quetiapine, Risperidone (for acute only), Olanzapine)

Antidepressants CI in acute manic episodes - elevates mood, worsening mania

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3
Q

What is the indication for lithium?

A

prescribe by BRAND

  • Bipolar disorder
  • Recurrent depression
  • Aggressive + self harm
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4
Q

What is the target therapeutic index of lithium?

A

0.4-1MMOL
- 12H after dose
- Regular monitoring: 3-6M

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5
Q

What are the signs of lithium toxicity?

A

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

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6
Q

What increases the risk of lithium toxicity?

A

Hyponatraemia

Renal impairment

Low fluid intake
- Caution: concomitant diuretics, intercurrent illness
- CI: low sodium diet, dehydration
- Monitor: electrolytes

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7
Q

What are the side effects of lithium?

A

Hypothyroidism

Nephrotoxicity

QT prolongation

Benign intracranial hypertension
- Counsel: Report persistent headaches + visual disturbances

Lower seizure threshold
- Monitor: epilepsy

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8
Q

Can you take lithium when pregnant?

A

Teratogenic
- Child bearing women: effective contraception
- Also present in breast milk + cause toxicity in infant

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9
Q

What are the interactions of lithium?

A
  • 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
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