Bipolar + Mania Flashcards
ICD 10 for mania
Elated mood + increased energy Decreased need for sleep, grandiosity, excessive optimism, pressure of speech At least 1 week duration
Hypomania S+S
No psychotic features + no impairment on functioning
Mania management
Acutely - antipsychotic + mood stabiliser Stop antidepressants
Lithium (SE, long term effects, interactions, contraindications, tests)
Must stay on for 3 years to avoid rebound mania Check renal function before starting SE: fine tremor, GI symptoms, muscle weakness, polyuria + polydipsia Long term effects: weight gain, decreased renal function, hypothyroidism, hyperparathyroidism, nephrogenic diabetes insipidus Teratogenic - causes Epstein abnormality NSAIDs, ACEis, diuretics = cause lithium toxicity Serum levels taken 12 hours post dose, 5-7 days then 3-4 monthly intervals
Lithium toxicity - what level, S+S
Occurs beyond 1.5mmol GI disturbances, nystagmus, course tremor, ataxia, LOC, seizures
ICD 10 Bipolar affective disorder
2 or more episodes of depression + mania/ hypomania
Management of bipolar
Manic episode = use antipsychotic Depressed episode = antidepressant + mood stabiliser SSRIs can cause mania
Valproate - action, uses, SE, contraindications
Enhance action of GABA Quicker onset than lithium, good for rapid cycling BAD. Better tolerated than lithium SE: nausea, tremor, sedation, weight gain, alopecia, blood dyscrasias, hepatotoxicity Avoided in women of child bearing age due to NTD
Lamotrigine - action, uses, SE
Enhance action of GABA Lamotrigine is more effective in depressive episodes. Fewer SE, no long term monitoring SE: N+V, headaches, blurred vision, flu symptoms, sedation, rash
Carbamazepine - action, uses, SE, contraindications
Enhance action of GABA Used for treatment resistant BAD SE: nausea, headache, sedation, ataxia, rashes Causes spina bifida in pregnancy Strong inducer of hepatic enzymes = lots of drug interactions INCREASES RISK OF AGRANULOCYTOSIS - don’t use with clozapine
