Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4. Mood Disorders > CANMAT Guidelines: Bipolar Disorder Part 3 + general Bipolar DSM > Flashcards

CANMAT Guidelines: Bipolar Disorder Part 3 + general Bipolar DSM Flashcards

1
Q

what are the most common comorbid conditions with BD

A

SUB

anxiety

personality disorder

impulse control disorder (ODD, ADHD, CD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the prevalence of SUDs in BD

A

33%-45%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the only treatment for alcohol use disorder co-morbid with BD in the guidelines with level 2 evidence (theres none higher)

A

lithium + divalproex (compared to lithium alone)

*watchout for electrolyte imbalances and liver function issues

theres level 3 and 4 evidence for other tx like disulfiram, naltrexone, gabapentin etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

is quetiapine recommended for treatment of AUD co-morbid with BD

A

no–lack of efficacy shown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what % of people with BD have cannabis use disorder

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what affect does cannabis have on course of BD

A

associated with more time in affective episodes and rapid cycling (as well as a bunch of other stuff like more psychotic features)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what medication showed benefit in treating cocaine use disorder co-morbid with BD

A

citicoline

also lithium and/or divalproex alone or in combo

buprioprion has anecdotal evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which medication has the most evidence of efficacy for treating OUD comorbid with BD

A

methadone

but lack of research in this area and there is concern with risk of overdose so should consult CRISM guidelines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what non-BD related medication may be reasonable to consider using to treat anxiety when comorbid with BD? why this med? do we have evidence for this?

A

pregabalin

effective and not associated with risk of mood destabilization and is well tolerated

not tested in BD population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

list medications that have evidence for treating anxiety symptoms/GAD in those with BD

A

quetiapine

lamotrigine or olanzapine + lithium in those who are euthymic and already on lithium

olanzapine + fluoxetine

gabapentin adjunctive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

does OCD have higher rates in those with BD compared to the general population

A

yes

*“some researchers have posited that the high rate of co-occurrence might reflect a distinct bipolar phenotype rather than separate disorders.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what % of those with BD also have a co-morbid personality disorder

A

42% per a meta analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what was the most prevalent co-morbid personality disorder with BD

A

obsessive compulsive PD

then borderline, then avoidant, then paranoid, then histrionic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what medications may provide relief for those with borderline PD co-morbid with BD

A

divalproex and lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what % of adults with ADHD also meet the criteria for BD

A

up to 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what % of patients with BD also meet criteria for adult ADHD

A

10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how do you approach treatment of comorbid ADHD and BD

A

treat the mood symptoms first then treat ADHD

reduced risk of mania with use of methylphenidate when treated concurrently with a mood stabilizer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

treatment with lithium was associated with reduced risk of what diseases

A

stroke and cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what baseline lab investigations should be done in patients with bipolar disorder

A

+ prolactin
+pregnancy test (if relevant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what medical monitoring should be done for those on lithium therapy

A

thyroid function
renal function
plasma calcium

–assessed at 6 months then at least annually thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what medical monitoring should be done for those on divalproex therapy

A

menstrual hx (to assess for PCOS)

hematology profile

liver function tests

–assessed at 3-6 month intervals during 1st year then at least annually thereafter

22
Q

what patient education should be done for those on carbamazepine or lamotrigine therapy

A

routine education about risks of skin rashes or potential for stevens johnson syndrome or toxic epidermal necrolysis

patients should contact healthcare professional if develop rash or mucosal ulcers

23
Q

which population should receive genetic screening before starting carbamazepine? why?

A

high risk populations like Han Chinese and other asian populations

make sure do not have human leukocyte antigen (HLA)-B*1502 allele–> confers high risk for SJS/TEN with carbamazepine

24
Q

what medical monitoring should be done for those on carbamazepine therapy

A

serum sodium levels at least annually due to risk of hyponatremia

25
Q

how often should you do serum levels for lithium and divalproex?

(note-should also do serum levels of carbamazepine, but just to check adherence)

A

two consecutive serum trough levels should be established in the acute phase

then q3-6 months or more frequently if clinically indicated

26
Q

what is the target serum level in acute treatment for lithium

A

0.8-1.2mEq/L

27
Q

what is the target serum level for lithium in maintenance treatment

A

0.6-1mEq/L (“may” be sufficient)

28
Q

how many days after the most recent dose titration should you get a level of lithium

A

about 5 days

29
Q

what is the target serum level of divalproex in the acute phase of treatment

A

350-700mM/L

(same during acute and maintenance)

30
Q

when should you get a divalproex level after the most recent dose change

A

3-5 days after

31
Q

can lithium cause weight gain

A

yes

so can divalproex

32
Q

can gabapentin cause weight gain

A

yes

33
Q

what is the effect of lurasidone on weight gain

A

minimal

34
Q

what GI side effects are commonly associated with lithium and divalproex

A

nauseu
vomiting
diarrhea

(35-45% of people experience this)

particularly pronounced during lithium initiation or rapid dose increases

35
Q

what % of patients on lithium report nephrogenic diabetes insipidus (NDI)

A

20-40%

36
Q

what % of patients on lithium will experience polyuria

A

upwards of 70%

37
Q

what long term effects can lithium have on the kidneys

A

i.e 10-20+ year admin of lithium can cause:

decrease glomerular filtration rate

chronic kidney disease (2x increased risk in older adults)

38
Q

what diseases can lithium cause due to renal toxicity

A

nephrogenic diabetes insipidus

chronic tubulointerstitial nephropathy

acute tubular necrosis

39
Q

when should you consult nephrology for your patient on lithium

A

if rapidly declining eGFR

if eGFR falls below 45 in two consecutive readings

if clinician is concerned

40
Q

can lithium cause QT prolongation

A

yes

41
Q

why do you screen for serum calcium in people on lithium

A

because lithium can cause hyperparathyroidism and serum calcium screens for this

if serum Ca elevated–> further investigate

42
Q

is hypothyroidism an indication for lithium cessation in a patient who has responded well to lithium

A

no not normally–> recommend thyroid supplementation instead

43
Q

what 3 APs are more likely to cause hyperprolactinemia

A

risperidone
paliperidone
amisulpride

44
Q

how might hyperprolactinemia persent

A

amenorrhea

sexual dysfunction

galactorrhea

gynecomastia

osteoporosis

45
Q

is lithium, lamotrigine or divalproex most likely to cause sedation

A

divalproex

46
Q

tremor is experiences by what % of those on lithium or divalproex

A

10%

47
Q

what should you rule out if your patient on divalproex presents with new onset neurological symptoms

A

hyperammonemic encephalopathy

can be fatal

48
Q

what % of patients being treated with lamotrigine will experience a non-serious rash

A

10%

49
Q

what % of patients being treated with lamotrigine will experience a serious rash like TEN or SJS

A

0.3-1%

risk MUCH lower with starting dose of 25mg and slow titration

50
Q

what skin conditions can be associated with lithium treatment

A

acne, psoriasis, eczema, hair loss, hidradenitis suppurativa, nail dystrophy and mucosal lesions

overall estimates ranging from 3% to 45% depending on the criteria applied

most cases can be managed without treatment discontinuation

51
Q

based on DSM V, is bipolar II still considered to be a “milder” form of bipolar I?

A

no–> this is because of the amount of time individuals with this condition spend in depression + because instability of mood w bipolar II typically accompanied by SERIOUS IMPAIRMENT in work and social functioning

4. Mood Disorders (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions