BIPOLAR/MANIA Flashcards
What is bipolar and mania?
Condition that affects mood which can swing from one extreme to another. Have periods/episodes of depression and mania.
How long should treatment lost for?
at least 2 years since last manic episode
up to 5 years if the patient has risk factors for relapse.
What are five treatment options?
Benzodiazepine
Antipsychotics
carbamazepine
valproate
lithium
What symptom can benzodiazepines be used to treat?
Treat behavioural disturbance or agitation
Not used for long due to risk of dependence
What are antipsychotics used to treat? which antipsychotics are used?
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
what can be added if response to antipsychotic is inadequate in treating hypomania and acute mania?
lithium or valproate
Asenapine; what is it and what is It used for?
a second generation antipsychotic drug
licensed for treatment to severe manic episodes associated with bipolar disorder
LITHIUM:
What is it indicated for?
treatment and prophylaxis of bipolar and mania.
Treatment of aggressive behaviour or self harming
prophylaxis of recurrent depression
LITHIUM:
How long can it take to work
6-12 months
LITHIUM:
What are cautions?
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)
LITHIUM:
What are monitoring requirements?
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
LITHIUM:
What are signs of toxicity?
Stop treatment immediately
Genitourinary;
GI upset
intoninence
polyuria
Neurological;
muscle weakness
fine tremor
CNS disturbances
abnormal reflexes
Other;
hyponatreamia
visual disturbances
LITHIUM:
what are target serum concentrations
0.4mmol-1mmol/L
0.8-1mmol/L for acute episodes
2.0> known to cause serious toxicity
LITHIUM:
What are signs of severe overdose?
cardiac arryhtmias
BP
Renal failure
coma
sudden death
LITHIUM:
What are important interactions?
NSAIDs and diuretics
increased risk of toxicity