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PR3153 > IC 13 - Bipolar Disorder > Flashcards

IC 13 - Bipolar Disorder Flashcards

1
Q

Bipolar Disorder is a _________ and ______ mood disorder.

A

lifelong, cyclical

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2
Q

What kind of episode is predominantly found in bipolar?

A

Depressive episodes (80%)

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3
Q

What kind of episode is common in the 1st episode of men?

A

Manic

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4
Q

Name one class of medications that can induce mania in bipolar depression patients.

A

Antidepressants

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5
Q

How does antidepressants induce mania in bipolar depression patients?

A

Increase norephedrine or dopamine transmission

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6
Q

Name 3 medical conditions that induce mania.

A
  1. CNS disorders (strokes, head injuries, multiple sclerosis)
  2. Endocrine or hormonal (Cushing’s disease, hyperthyroidism (mania), hypothyroidism (depression))
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7
Q

What are 5 drugs/ things that can induce mania?

A
  1. Drug withdrawal states
  2. Antidepressants
  3. DA augmenting agents
  4. Steroids
  5. Thyroid preparations
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8
Q

What is the key features of bipolar disorder?

A

History of mania or hypomania (Not due to other conditions)

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9
Q

What is the main manic symptoms?

A

Abnormal and persistently elevated/ expansive/ irritable mood

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10
Q

What is D.I.G.F.A.S.T.?

A
  1. Distractibility and easily frustrated
  2. Irresponsibility and erratic uninhibited behavior
  3. Grandiosity (inflated self esteem)
  4. Flight of ideas
  5. Activity increased
  6. Sleep: need is decreased
  7. Talkativeness
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11
Q

What is the clinical presentation of mania/bipolar?

A

Digfast symptoms (≥ 1 week with functional impairment)

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12
Q

What does bipolar I disorder refer to?

A

Mania ± Depressive episode

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13
Q

What are the important assessment that should be done to diagnose bipolar disorder?

A

Psychiatric history, mental state exam (suicidal/ homicidal ideations and risks)

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14
Q

What are the labs and investigation that should be done for bipolar disorder?

A

HLA-B*1502, FBC, U/E/Cr, LFTs, TFTs, pregnancy test

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15
Q

List 2 goals of treatments of Bipolar disorder

A
  1. Reduce frequency, severity and duration of mood episodes
  2. Prevent suicide
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16
Q

Name 4 non-pharmacological methods that can be used for bipolar disorder.

A
  1. Psychotherapy
  2. Stress reduction
  3. Educate on recognising s/sx early
  4. Sleep hygiene
17
Q

Name 2 broad classes of drugs that can be used for bipolar disorder.

A
  1. Benzodiazepines
  2. Mood stabiliser e.g. lithium
18
Q

What are the medications that can be used for mania?

A
  1. Antipsychotics (Olanzapine, Quetiapine, Risperidone, Haloperidol)
  2. Lithium (1st line for maintenance and relapse/ suicide prevention)
19
Q

What are the medication for bipolar depression?

A
  1. Lithium (1st line)
  2. Quetiapine
  3. Olanzapine with Fluoxetine
  4. Lamotrigine
20
Q

Which population should not use valproate?

A

Women of childbearing potential

21
Q

What are the side effects of lithium?

A
  1. Hypothyroidism
  2. Fine to coarse tremors
  3. Polyuria
  4. Cardiac effects (ECG)
  5. Nausea
22
Q

What are some interactions that may lead to Li+ toxicity?

A
  1. Decrease sodium
  2. Thiazides
  3. ACEI/ ARBs
  4. NSAIDs
  5. Dehydration
23
Q

What are two side effects of sodium valproate?

A
  1. Decrease platelet
  2. Pancreatitis
24
Q

Name one DDI associated with sodium valproate.

A

Lamotrigine (Risk of SJS)

25
Q

What is one DDI of carbamazepine.

A

Clozapine with agranulocytosis

26
Q

What are the side effects of lamotrigine?

A

Sedation and weight gain (but lesser than others)

27
Q

What are the antipsychotics side effects?

A

EPSE, metabolic S.E, increase weight

28
Q

What is one feature of carbamazepine metabolism?

A

Induces its own metabolism and that of other drugs

29
Q

List three drugs that requires us to watch out for SJS/TEN.

A

Lamotrigine/ VPA/ carbamazepine

30
Q

What labs should be tested after initiation of Lithium and carbamazepine?

A

Low natremia

31
Q

When is long-term lithium required?

A

Recurrent depressive episodes

32
Q

For bipolar disorder with rapid cycling, _____ antidepressants/stimulants.

A

avoid

33
Q

What is the non-pharm treatment for severe mania in pregnancy?

A

ECT for severe

34
Q

What is the drug of choice for liver impairment in bipolar disorder?

A

Lithium

35
Q

What medications can be used for aggression/ violence?

A

Lithium or valproate, consider adding antipsychotic

PR3153 (16 decks)

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