Bipolar Disorder & Mania Flashcards
How long should bipolar disorder treatment last for?
Long term treatment should continue for at least 2 years from the last manic episode.
Upto 5 years if patient has risk factors for relapse
An anti-depressant can be used as additional treatment - which patients should NOT use this?
Patients with rapid -cycle bipolar disorder
Recent history of hypomania
Rapid mood fluctuations
Which drug groups can be used in general for bipolar disorder?
Anti-psychotics
Benzodiazepines
Anti-epileptics e.g. Carbamazepine, Valproate
Lithium
Give examples of the anti-psychotics that can be used in newly diagnosed bipolar disorder
Haloperidol
Olanzapine
Quetiapine
Risperidone
If response to anti-psychotic is not adequate what can be added?
Lithium or Valproate (Valproic acid & sodium valproate)
How would you discontinue anti-psychotic treatment?
- if they are on another anti manic drug
- if patient is not continuing with another anti-manic drug or there is a history of relapse?
- gradually reduce dose over 4 weeks
2. withdrawal period of 3 months
When can carbamazepine be used?
Used under specialist supervision in prophylaxis when patients unresponsive to other combination of drugs
Also can be used in rapid-cycle manic-depressive illness (4 or more in a year)
How long does it take to see the full prophylactic effects of Lithium in bipolar disorder?
6 to 12 months
What is the dose of valproic acid in bipolar disorder?
initially 750mg daily in 2-3 divided doses then increased to 1-2g daily according to response.
Doses greater 45mg/kg daily require monitoring
What is the MHRA advise on Valproate meds in women?
Valproate high tetrogenic - leds to congenital malformations and neurodevelopmental disorders.
Must not be used in women and girls of child bearing age unless conditions of pregnancy prevention programme are met and if other treatments are ineffective or not tolerated.
In pregnancy it is CONTRAINDICATED for bipolar disorder and migraine. ONLY for EPILEPSY
