BIPOLAR/MANIA

Question 1

What is bipolar and mania?

Answer 1

Condition that affects mood which can swing from one extreme to another. Have periods/episodes of depression and mania.

Question 2

How long should treatment lost for?

Answer 2

at least 2 years since last manic episode
up to 5 years if the patient has risk factors for relapse.

Question 3

What are five treatment options?

Answer 3

Benzodiazepine
Antipsychotics
carbamazepine
valproate
lithium

Question 4

What symptom can benzodiazepines be used to treat?

Answer 4

Treat behavioural disturbance or agitation

Not used for long due to risk of dependence

Question 5

What are antipsychotics used to treat? which antipsychotics are used?

Answer 5

First line option
Acute episodes of mania or hypomania
If effective can be used for the long term use of bipolar disorder

haloperidol, olanzapine, quetiapine, and risperidone

Question 6

what can be added if response to antipsychotic is inadequate in treating hypomania and acute mania?

Answer 6

lithium or valproate

Question 7

Asenapine; what is it and what is It used for?

Answer 7

a second generation antipsychotic drug

licensed for treatment to severe manic episodes associated with bipolar disorder

Question 8

LITHIUM:

What is it indicated for?

Answer 8

treatment and prophylaxis of bipolar and mania.
Treatment of aggressive behaviour or self harming
prophylaxis of recurrent depression

Question 9

LITHIUM:
How long can it take to work

Answer 9

6-12 months

Question 10

LITHIUM:
What are cautions?

Answer 10

CARDIAC;
Cardiac disease,
QT prolongation,
diuretic treatment increases risk of toxicity

Neurological;
Epilepsy
Avoid abrupt withdrawals

Pregnancy;
avoid in pregnancy especially first trimester

Other;
concurrent ECT
psoriasis(risk of exacerbation)

Question 11

LITHIUM:
What are monitoring requirements?

Answer 11

serum concentrations samples should be taken 12 hours
routine serum monitoring- weekly after initiation and after each dose change

then every 3 months for the first year, then every 6 months
Patients at higher risk should be monitored every 3 months
Before and 6 monthly initiation;
renal impairment
cardiac function
thyroid function
BMI
Electrolytes- esp calcium
FBC- only before

Question 12

LITHIUM:
What are signs of toxicity?

Answer 12

Stop treatment immediately
Genitourinary;
GI upset
intoninence
polyuria

Neurological;
muscle weakness
fine tremor
CNS disturbances
abnormal reflexes

Other;
hyponatreamia
visual disturbances

Question 13

LITHIUM:
what are target serum concentrations

Answer 13

0.4mmol-1mmol/L
0.8-1mmol/L for acute episodes

2.0> known to cause serious toxicity

Question 14

LITHIUM:
What are signs of severe overdose?

Answer 14

cardiac arryhtmias
BP
Renal failure
coma
sudden death

Question 15

LITHIUM:
What are important interactions?

Answer 15

NSAIDs and diuretics
increased risk of toxicity

Question 16

LITHIUM:
How should it be stopped and why?

Answer 16

abrupt stopping increases risk of relapse so has to be reduced over at least 4 weeks up to 3months .

Question 17

LITHIUM:
what is patient and carer advice?

Answer 17

Carry lithium book
maintain adequate fluid intake and avoid changing salt amount in diet- lithium toxicity is worsened by sodium depletion
Driving may be impaired
Aware of signs of toxicity

Question 18

when should antidepressants be avoided?

Answer 18

Can be used for bipolar depression but avoided in patients rapid cycling bipolar disorder a recent history of mania or hypomania, or with rapid mood fluctuations. Consider stopping if the patient develops mania or hypomania.

Question 19

Valproate:
what are indications?

Answer 19

valproic acid and sodium valproate is used for manic episodes associated with bipolar disorder if lithium is not tolerated

Long term treatment of bipolar to prevent recurrence of acute episodes in combo with lithium if monotherapy of lithium is not tolerated or contraindicated.

Question 20

Carbamazepine:
what is it licensed for?

Answer 20

Long term treatment of bipolar disorder, to prevent recurrent acute episodes in patients unresponsive to lithium therapy.