Bipolar Jeopardy Flashcards
Bipolar I
@18yo \+delusions Depressive episode is not dx requirement More likely to have hypomanic episode Significant impairment in social or occupational function Need psychiatric hospitalization
Bipolar II
@mid 20s F = M Sx for 4-6 days Pt in depressed state 15 x more than (hypo)manic state Mistaken for cyclothymia
Bipolar I or II
may present with mixed features
males
manic episode = most likely to have first mood disturbance
If the 1st mood disturbance is
a manic episode the risk of future mood episodes is ?
85%
Identical Twin diagnosed with Bipolar Disorder, your risk is?
70%
With each ensuing episode, the length of time a patient spends in a manic episode ?
Increases / Lengthens
family history of bipolar disorder
Inc risk if +maternal
lower risk if +paternal
After the first mood disturbance in Major Depression, the risk of future depression episodes
is?
50%
After 2 episodes, risk is ~70%
After 3 episodes, risk is ~90+%–definitely do maintenance treatment to avoid # of manic episodes)
For patients with bipolar disorder, as the total number of mood episodes increases, the inter episode interval?
decreases/shortensy
Divalproex
Depakote
Avoid in bipolar pts with LIVER disease
Rapidly loaded
Pts improve most in first 3 days
rx of 1500 mg to rapidly load a patient weighing
150 pounds with 20 mg/kg of rx
Lithium or Divalproex
rule of 1/3
1/3 respond well
1/3 partial respond
1/3 respond poorly
Lithium
response rate = VERY GOOD
decrease risk of suicide
avoided in treating bipolar patients with RENAL disease
discontinued gradually to avoid affective switch to mania
Narrow therapeutic range
Cardiotoxicity
treating bipolar patients with euphoric mood, family history of the illness, and/or few lifetime episodes
TX severe acute manic episode
Lithium + FGA/SGA
or
divalproex (depakote) + FGA/SGA?
maintenance tx
recommended after 1 or 2 manic episodes
Olanzapine
Zyprexa
avoid in OBESE pts
olanzapine/fluoxetine
Symbyax
TX for bipolar depression
NO risk for a switch to mania
tricyclic antidepressants (TCAs) serotonin-norepinephrine reuptake inhibitors (SNRI’s)
Increased switch rate
Increase in the number of rapid cycling cases
antidepressant monotherapy
Contraindicated in pts with bipolar I depression
Buproprion
least risk of inducing a manic episode
TX x bipolar depression
Lithium Quetiapine Lurasidone Lamotrigine Olanzapine/fluoxetine
discontinue antidepressant after episode
Aripiprazole
abilify
this SGA is NOT shown to be beneficial in the treatment of bipolar depression
Lamotrigine
lamictal
treat acute bipolar depression
maintenance treatment
NOT for an acute manic episode
suicide risk in bipolar pts
16% (~major depression)
20x more than general population
