CANMAT bipolar I and II Flashcards
1st line monotherapy for acute bipolar I mania
monotherapy: Li Epival Almost Any AA: ROQA ZAP (olanzapine, risperidone, quetiapine, aripiprazole, asenapine, paliperidone ER, ziprazidone)
1st line combo therapy for acute bipolar I mania
Li OR epival plus: ROQAA (you rock when you're 1st line maniac) risperidal olanzapine Quetiapine Aripiprazole Asenapine
2nd line monotherapy for acute bipolar 1 mania
HEC (hectagons may have many sides, but 2nd line BD1 mania is short and sweet)
Haldol
ECT
Carbamazepine
2nd line combo for acute bipolar 1 mania
Li+ Epival
3rd line monotherapy for acute bipolar 1 mania
non-comprehensive list: COT
clozapine
oxcarbazepine
tamoxifen (mono or adj)
not recommended for acute bipolar 1 mania
mono: Vera and Gaba were tied on top of the lama
verapamil gabapentin, tiagabine, topiramate, lamotrigine
combo: risperidoe or olanzapine with carbamazepine
all 1st line for acute bipolar I mania
Monotherapy: Li Epival Almost any ROQA ZAP Any AA (olanzapine, risperidone, quetiapine, aripiprazole, asenapine, paliperidone ER, ziprazidone)
Combi therapy: Li OR epival plus: ROQAA (you rock when you're 1st line maniac) risperidal olanzapine Quetiapine Aripiprazole Asenapine
all 2nd line for acute bipolar 1 mania
Mono: HEC (hectagons may have many sides, but 2nd line BD1 mania is short and sweet) Haldol ECT Carbamazepine
Combi:
Li+ Epival
1st line for bipolar I acute depression
Mono:
Li
Lamotrigine
Quetiapine
Combi:
Li+epival
Li or epival + SSRI or Buproprion
Olanzapine + SSRI
2nd line bipolar I acute depression
mono:
epival, lurasidone
combi:
Li or epival plus lamotrigine or lurasidone
quetiapine +SSRI
adj modafinil
3rd line bipolar I acute depression
not comprehensive list:
quetiapine + lamotrigine
Li Plus: MAOI, pramipexole, or carbamazepine
Li or Epival plus: TCA or venlafaxine
not recommended bipolar I acute depression
It’s not recommended to ZAG alone when depressed
Ziprazidone
Aripiprazole
Gabapentin
adj ziprazidone
adj Leveteracetam
1st line bipolar I maintenance
Mono: Li epival lamotrigine AA: ROQA not ZAP (zipraz, paliperidone, asenapine) which are there fr acute
comb: Li or epival plus: RAQZ (3ashan ti7fath) Risperdal Abilify Quetiapine ziprazidone
Note :risp is LAI
2nd line Bipolar 1 maintenace
mono: CP
Combo: LiO
CP LELCRO OLEF
Mono:
carbamazepine
Paliperidone ER
Combi: Li plus: ELCRO= L ELCRO divalproex carbamazepine lamotrigine
risperdal (reg)
olanzapine
Olanzapine plus: LEF= OLEF
Li
Epival
Fluoxetine
3rd line bipolar I mainitenence
asenapine adj COT clozapine oxcarbazepine ? ECT (which is always 3rd line except in bipolar mania acute: 2nd )
not recommended Bipolar 1 DO maintenece
Not recommended to play TAG long term gabapentin topiramate antidepressants adj flupenthixol
1st line for acute bipolar II depression
Quetiapine
2nd line for acute bipolar II depression
lamotrigine, Li, divalproex
Li or divalproex or AA plus antidepressant
Li plus divalproex
2nd line BD2=1st L BD1
3rd line for acute bipolar II depression
antidepressants alone (as an exception) quetiapine+ lamotrigine adj ECT adj T3 adj NAC
Not recommended for acute bipolar II depression
antidepressant monotherapy (but 3rd line)
1st line bipolar II maintenance
1st line here is only mono
quetiapine, lamotrigine, Li
2nd line bipolar II maintenance
Similar to 2nd line acute bipolar II, but mostly combo
Only epival is mono, so:
divalproex
Desperation with these patients. anything goes:
any combo of 2 mood stabilizers, or of Li, epival, AA
Li or divalproex or mood stabilizer or AA plus antidepressant
specifically though encompassed above.
adj quetiapine
adj lamotrigine
Not recommended for maintenence bipolar II depression
gabapentin as ususual
3rd line bipolar II maintenance
ECT, carbamazepine, oxcarbazepine, AA, fluoxetine
rapid cycling RF
Factors favoring its occurrence include: • female gender; • borderline hypothyroidism • menopause; • temporal lobe dysrhythmias • BAD-II • substance abuse
what is gabapentin not recommended for?
acute BD1 depression
acute BD 1 mania
BD1 maintenance
BD 2 maintenance
2005 mixed states
epival
carbamaz (it’sa predictor of response to carbamaz)
oxcarbaz
olanzapine
ECT
combination likely needed
2013 added that asenapine decreased depressive sx, and olanzapine decreased both depressive and manic sx
riperidone andziprazidone also mentioned.
2005 rapid cycling
epival plus Li
epival
olanzapine (and AA in general)
ECT
combination Li or carbamaz with something better than either alone
(rapid cycling is a predictor of non response to carbamaz)
2013 prevalence of BD1 BD2 NOS sex ratio
0.6%
0.4%
1.5%
all together makes 2.5 %
equal
emergency tx of mania
oral : ROS
IM:OAZ, Haldol plus ativan
not benzo alone
RF for recurrence in rapid cyclers
SUD
early verbal abuse
female
late onset depressive sx
rate of rapid cycling
rate of mixed episodes
rate of psychotic sx
20%, STEP BD: 5%
70% in BD2, 65% in BD I, STEP BD 15%
30-50%
manic switch with antidperessants
more in bipolar 1
TCA and effexor: 13-38%
vs Wellbutrin and SSRI 3-11%
76% with subsances
cognitive deficits in BD 1 and 2
same but 2 have better memory and semantics and improve with donepezil
CVD mortality more in 1 or 2?
2 is double
migraines?
32% of BD 2, 20% of1
Rates of CB: obesity: DM migraines SUD nicotene anxiety
Obesity 42% DM: 27% migraines: 25% SUD: 70% nicotine: 25 %(? 32 in step BD) anxiety: 50% (? 32 in step BD) ADHD 18% (? 10% in step BD)
# 1 CB in geri adults adolescents children
neuro dis
SUD (if not a choice, anxiety)
ODD (90%, vs ADHD is 85%)
ADHD
FDA approved AA for bipolar in adolescents
ROQA
geri bipolar chch
more:
rapid cycling
mixed
good prognosis
less:
suicide attempts
severe manias
psychotic sx
same depressive sx
late onset is over 50
predictors of response to AA
young age of onset
rapid cycling
no antipsychotics or drugs rior
predictors of response to carbamaz
mixed more manic states severe mania no fmily hisory early onst
non responseif >10 yrs of illness, rapid cycling
