CANMAT bipolar I and II Flashcards by wid kattan

1st line monotherapy for acute bipolar I mania

monotherapy:
Li
Epival
Almost Any AA:
ROQA ZAP
 (olanzapine, risperidone, quetiapine, aripiprazole, asenapine, paliperidone ER, ziprazidone)

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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

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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

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2nd line combo for acute bipolar 1 mania

Li+ Epival

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3rd line monotherapy for acute bipolar 1 mania

non-comprehensive list: COT
clozapine
oxcarbazepine
tamoxifen (mono or adj)

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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

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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

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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

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1st line for bipolar I acute depression

Mono:
Li
Lamotrigine
Quetiapine

Combi:
Li+epival
Li or epival + SSRI or Buproprion
Olanzapine + SSRI

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2nd line bipolar I acute depression

mono:
epival, lurasidone

combi:
Li or epival plus lamotrigine or lurasidone
quetiapine +SSRI
adj modafinil

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3rd line bipolar I acute depression

not comprehensive list:
quetiapine + lamotrigine
Li Plus: MAOI, pramipexole, or carbamazepine
Li or Epival plus: TCA or venlafaxine

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not recommended bipolar I acute depression

It’s not recommended to ZAG alone when depressed
Ziprazidone
Aripiprazole
Gabapentin

adj ziprazidone
adj Leveteracetam

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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

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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

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3rd line bipolar I mainitenence

asenapine
adj COT
clozapine
oxcarbazepine 
?
ECT (which is always 3rd line except in bipolar mania acute: 2nd )

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not recommended Bipolar 1 DO maintenece

Not recommended to play TAG long term
gabapentin
topiramate
antidepressants
adj flupenthixol

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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