IC 13 - Bipolar Disorder Flashcards
Bipolar Disorder is a _________ and ______ mood disorder.
lifelong, cyclical
What kind of episode is predominantly found in bipolar?
Depressive episodes (80%)
What kind of episode is common in the 1st episode of men?
Manic
Name one class of medications that can induce mania in bipolar depression patients.
Antidepressants
How does antidepressants induce mania in bipolar depression patients?
Increase norephedrine or dopamine transmission
Name 3 medical conditions that induce mania.
- CNS disorders (strokes, head injuries, multiple sclerosis)
- Endocrine or hormonal (Cushing’s disease, hyperthyroidism (mania), hypothyroidism (depression))
What are 5 drugs/ things that can induce mania?
- Drug withdrawal states
- Antidepressants
- DA augmenting agents
- Steroids
- Thyroid preparations
What is the key features of bipolar disorder?
History of mania or hypomania (Not due to other conditions)
What is the main manic symptoms?
Abnormal and persistently elevated/ expansive/ irritable mood
What is D.I.G.F.A.S.T.?
- Distractibility and easily frustrated
- Irresponsibility and erratic uninhibited behavior
- Grandiosity (inflated self esteem)
- Flight of ideas
- Activity increased
- Sleep: need is decreased
- Talkativeness
What is the clinical presentation of mania/bipolar?
Digfast symptoms (≥ 1 week with functional impairment)
What does bipolar I disorder refer to?
Mania ± Depressive episode
What are the important assessment that should be done to diagnose bipolar disorder?
Psychiatric history, mental state exam (suicidal/ homicidal ideations and risks)
What are the labs and investigation that should be done for bipolar disorder?
HLA-B*1502, FBC, U/E/Cr, LFTs, TFTs, pregnancy test
List 2 goals of treatments of Bipolar disorder
- Reduce frequency, severity and duration of mood episodes
- Prevent suicide
Name 4 non-pharmacological methods that can be used for bipolar disorder.
- Psychotherapy
- Stress reduction
- Educate on recognising s/sx early
- Sleep hygiene
Name 2 broad classes of drugs that can be used for bipolar disorder.
- Benzodiazepines
- Mood stabiliser e.g. lithium
What are the medications that can be used for mania?
- Antipsychotics (Olanzapine, Quetiapine, Risperidone, Haloperidol)
- Lithium (1st line for maintenance and relapse/ suicide prevention)
What are the medication for bipolar depression?
- Lithium (1st line)
- Quetiapine
- Olanzapine with Fluoxetine
- Lamotrigine
Which population should not use valproate?
Women of childbearing potential
What are the side effects of lithium?
- Hypothyroidism
- Fine to coarse tremors
- Polyuria
- Cardiac effects (ECG)
- Nausea
What are some interactions that may lead to Li+ toxicity?
- Decrease sodium
- Thiazides
- ACEI/ ARBs
- NSAIDs
- Dehydration
What are two side effects of sodium valproate?
- Decrease platelet
- Pancreatitis
Name one DDI associated with sodium valproate.
Lamotrigine (Risk of SJS)
What is one DDI of carbamazepine.
Clozapine with agranulocytosis
What are the side effects of lamotrigine?
Sedation and weight gain (but lesser than others)
What are the antipsychotics side effects?
EPSE, metabolic S.E, increase weight
What is one feature of carbamazepine metabolism?
Induces its own metabolism and that of other drugs
List three drugs that requires us to watch out for SJS/TEN.
Lamotrigine/ VPA/ carbamazepine
What labs should be tested after initiation of Lithium and carbamazepine?
Low natremia
When is long-term lithium required?
Recurrent depressive episodes
For bipolar disorder with rapid cycling, _____ antidepressants/stimulants.
avoid
What is the non-pharm treatment for severe mania in pregnancy?
ECT for severe
What is the drug of choice for liver impairment in bipolar disorder?
Lithium
What medications can be used for aggression/ violence?
Lithium or valproate, consider adding antipsychotic
