Chapter 28: Bipolar Disorders

Question 1

BPD

Answer 1

Formerly known as manic-depressive illness
Afflicts an estimated 3.7% of the adult population
Mainstays of therapy are lithium and valproic acid
Many patients also receive an antipsychotic
Chronic condition that requires lifelong treatment
Cause may be disruption of neuronal growth and survival

Definition of bipolar disorder (BPD)
Cyclic disorder
Recurrent fluctuations in mood
Episodes of mania and depression persist for months without treatment

Treatment
Drugs
Psychotherapy

Question 2

Characteristics of Bipolar Disorder

Answer 2

Types of mood episodes seen with BPD:
Pure manic episode (euphoric mania)
Hypomanic episode (hypomania)
Major depressive episode (depression)
Mixed episode

Question 3

Types of drugs for BPD

Answer 3

Mood stabilizers: Lithium, divalproex sodium, and carbamazepine
Relieve symptoms during manic and depressive episodes
Prevent recurrence of manic and depressive episodes
Do not worsen symptoms of mania or depression; do not accelerate the rate of cycling

Antipsychotics
Given during severe manic episodes

Antidepressants
Given during depressive episodes

Question 4

Drug selection for BPD

Answer 4

Short-term therapy for manic episodes: Lithium and valproate
Short-term therapy for depressive episodes: Lithium or valproate, bupropion, venlafaxine, or a selective serotonin reuptake inhibitor
Long-term preventive treatment: Antipsychotic agents

Question 5

BP promo compliances

Answer 5

Short-term hospitalization
Long-term prophylactic therapy
Education for both patient and family

Question 6

BPD nondestructive therapy

Answer 6

Education
Patient and family

Psychotherapy
Individual, group, and family

Electroconvulsive therapy
Last resort

Question 7

Mood stabilizing drugs

Answer 7

Lithium
Low therapeutic index

Question 8

Lithium [Lithonate, Lithotabs] chem

Answer 8

Simple inorganic ion
Found naturally in animal tissues

Question 9

Li therapeutic uses

Answer 9

BPD
Other uses
Alcoholism
Bulimia
Schizophrenia
Glucocorticoid-induced psychosis

Question 10

LI MOA

Answer 10

Neurotrophic
Neuroprotective

Question 11

Li pharmacokinetics

Answer 11

Excretion
Short half-life
Excreted by the kidneys
Sodium levels: Lithium excretion reduced when sodium level is low

Plasma levels
0.8 to 1.4 mEq/L

Question 12

Li ADRs

Answer 12

Excessive lithium levels
Greater than 1.5 mEq/L
Monitor levels every 2 to 3 days at initiation of therapy and then every 3 to 6 months

Therapeutic lithium levels
Gastrointestinal effects
Tremors
Polyuria
Renal toxicity
Goiter and hypothyroidism
Teratogenesis

Question 13

Li drug interactions

Answer 13

Diuretics
Nonsteroidal antiinflammatory drugs
Anticholinergic drugs

Question 14

Li prep

Answer 14

Lithium carbonate
Lithium citrate
Dosage is highly individualized

Question 15

Antiepileptic drugs

Answer 15

Divalproex sodium [Valproate]
Carbamazepine
Reduces symptoms
Protects against recurrence of mania and depression
Target trough plasma level: 4 to 12 mcg/mL

Lamotrigine
Indicated for long-term maintenance
Can be used alone or in combination with other drugs

Question 16

Antipsychotic drug

Answer 16

Used to acutely control symptoms during manic episodes
Used long term to help stabilize mood
Benefit patients with or without psychotic symptoms
Can be combined with mood stabilizer
Five antipsychotics approved for use
Olanzapine [Zyprexa], quetiapine [Seroquel], risperidone [Risperdal], aripiprazole [Abilify], and ziprasidone [Geodon]