Bipolar disorder and mania Flashcards
What are the two types of bipolar disorder episodes ?
Mania- feeling very high and overactive. Less severe mania is called hypomania
Depression- feeling very low and lethargic
Which antipsychotics are useful in acute episodes of mania and hypomania?
Second generation antipsychotics: quetiapine, olanzapine, ripseridone
What other drugs can be added to antipsychotics in bipolar disorder if response is inadequate ?
Lithium or varlpoic acid
What drug can be given in moderate-severe manic episodes ?
asenapine ( second generation antipsychotic drug )
What drugs are used in prophylaxis of bipolar disorder?
Lithium salts, olanzapine ( if response in manic episode )
valproate, carbamazepine ( rapid-cycling bipolar disorder unresponsive to other drugs )
What are the contraindications in bipolar disorder ?
Do not give antidepressants if rapid cycling bipolar disorder, recent history of hypomania, manic episode, rapid mood fluctuations
What are the Lithium uses ?
prophylaxis and treatment of mania, hypomania, and depression in bipolar disorder, resistant depression and aggressive or self-harming behaviour
Whats is Lithium therapeutic range ?
- 0.4 mmol/L to 1 mmol/L ( lower end for prophylactic treatment/ elderly )
- 0.8 mmol/l to 1 mmol/l for acute manic episodes, patients who have previously relapsed or have subsyndromal symptoms
When should lithium blood samples must be taken ?
12 hours post dose
How often lithium levels should be monitored ?
every three months
When would additional monitoring for lithium would be indicated ?
significant intercurrent illness or significant changes to diet or water intake
Why should abrupt withdrawal of lithium should be avoided ?
higher risk of relapse
What are the signs and symptoms of Lithium toxicity ?
- Renal disturbances : polyuria, incontinence, hypernatraemia
- Extrapyramidal symptoms : fine tremor increasing to course tremor, ataxia, dysarthria, myoclonus, nystagmus and muscle weakness
- Visual disturbance: blurred vision
- Nervous system disturbances: confusion and drowsiness increasing to incoordination, restlessness and stupor
- GI effects: diarrhoea and vomiting
What symptoms occur when Lithium levels are above 2 mmol/l ?
renal failure, arrhythmias, bradycardia, seizures, BP changes, circulatory failure, coma and sudden death
What side effects occurs due to long term use of lithium ?
mild cognitive/ memory impairment, thyroid disorders
Lithium side effects ?
Hypo/hyperthyroidism Renal impairment Benign intracranial hypertension QT prolongation Lowers seizure treshold
What are the lithium monitoring requirements ?
thyroid function tests, renal function tests, cardiac function
Which electrolyte disturbances predispose to lithium toxicity ?
hyponatraemia
How should patients on Lithium be counselled ?
Maintain constant, adequate salt and water intake ( prevent dehydration ).
Lithium can cause drowsiness.
Avoid alcohol
Avoid ibuprofen, soluble analgesics, antacids
Is lithium safe in pregnant or breastfeeding women ?
Teratogenic: effective contraception must be in place
Toxicity can occur in breast fed infants
Lithium lowers seizure threshold, therefore when given with certain drugs may result in increased risk of seizures ? What are these certain drugs ?
Quinolones, SSRIs, epilepsy
Lithium causes QT prolongation, which other drugs cause QT prolongation ?
quinolones, SSRIs, clarithromycin, amiodarone, antipsychotics, imipramine,
Hypokalaemia can result in QT prolongation and therefore drugs that cause hypokalaemia should be avoided with lithium ?
theophylline, corticosteroids, B2 agonists, loop/thiazide diuretics
Which drugs reduce renal excretion and therefore increases the risk of lithium toxicity ?
ACE inhibitors/ARBs, NSAIDs ( nephrotoxic drugs )
