Chapter 65: Bipolar Disorder

Question 1

Bipolar I

Answer 1

At least one episode of mania, and usually bouts of intense depression (depressive episode is not required for diagnosis)

Question 2

Mania

Answer 2

Is associated with at least one of the following:
significant impairment in social/work functioning
psychosis/delusions or requires hospitalization

Question 3

Bipolar II

Answer 3

At least one episode of hypomania (lasting >= 4 days) and at least one depressive episode (lasting >= 2 weeks)

Question 4

Bipolar Depression

Answer 4

Predominant symptoms of a depressive episode include feelings of sadness or depressed mood and/or loss of interest in previously enjoyed activities

Question 5

Psychosis

Answer 5

Severe mental condition where there is a loss of contact with reality, involves abnormal thinking and perception (hallucinations and delusions)

Question 6

Tx for Mania and Depression

Answer 6

• Lithium
• Valproate
• Lamotrigine
• Carbamazepine

Question 7

Acute Treatment: Manic Episode

Answer 7

1st line is valproate, lithium or antipsychotic

Combo lithium or valproate + antipsychotic for severe episode

Question 8

Acute Treatment: Depressive Episode

Answer 8

1st line is lithium but lamotrigine can be used as an alternative

Question 9

Maintenance Monotherapy

Answer 9

Lithium and valproate are preferred for monotherapy

lamotrigine, carbamazepine and other SGAs can be used

Question 10

Pregnancy and Valproate

Answer 10

Can cause adverse cognitive effects

Question 11

Pregnancy and Carbamazepine

Answer 11

Facial Abnormalities

Question 12

Pregnancy and Lithium

Answer 12

Increased congenital cardiac malformation

Question 13

Preferred Tx in Pregnancy

Answer 13

Lamotrgine is safer option

Lurasidone is most favorable but only indicated in bipolar depression

Question 14

SGAs used for acute mania/maintenance

Answer 14

• Aripiprazole
• Olanzapine
• Quetiapine
• Risperidone
• Ziprasidone
• Lurasidone

Question 15

Lithium Therapeutic Range

Answer 15

0.6-1.2 meq/L

Question 16

Lithium Warnings

Answer 16

Serotonin Syndrome

Question 17

Lithium SE

Answer 17

GI upset
Cognitive effects
Cogwheel rigidity
Fine hand tremor
Thirst, Polyuria/polydipsia
Weight gaine
Hypothyroidism

Question 18

Lithium Toxicity

Answer 18

> 1.5meq/L: ataxia, coarse hand tremor, vomiting

>2.5meq/L: CNS depression, arrhythmia, seizure, come

Question 19

Lithium Monitoring

Answer 19

Lithium levels
Renal Function
Thyroid function

Question 20

Lithium Notes

Answer 20

Renally cleared

Avoid in Pregnancy

Question 21

Lithium and Salt intake

Answer 21

Lithium level increases with decreased salt intake (and Nsaids, asa and sulindac safer)
Lithium level decreases with increased salt intake

Question 22

Converting between lithium formulation

Answer 22

5ml lithium citrate = 8 meq lithium ion

8 meq lithium ion = 300mg lithium carbonate