Mania and Hypomania Flashcards
Antimanic drugs are used in ___________ to manage acute episodes of mania or hypomania, and to prevent recurrence
bipolar disorder
Are antidepressants used in the treatment of bipolar disorder?
Sometimes; An antidepressant drug may be required in addition to antimanic medication for the treatment of co-existing bipolar depression, but should be avoided in patients with rapid-cycling bipolar disorder, a recent history of mania or hypomania, or with rapid mood fluctuations.
An antidepressant drug may also be required for the treatment of co-existing bipolar depression, but should be avoided in patients with _____________, ________________, or with _____________.
rapid-cycling bipolar disorder
a recent history of mania or hypomania
rapid mood fluctuations
Consider stopping antidepressant drug if a patient with bipolar disorder develops __________ or ___________
mania
hypomania
Which drugs are used in the treatment of acute episodes of mania or hypomania?
Antipsychotics eg haloperidol, olanzapine, quietiapine, risperidone
Lithium or valproate may be added if inadequate response to other agents
A(n) ______________ drug may also be used concomitantly with lithium or valproate in the initial treatment of severe acute episodes of mania
antipsychotic
____________, a second-generation antipsychotic drug, is licensed for the treatment of moderate to severe manic episodes associated with bipolar disorder.
Asenapine
____________ can be used for the long-term management of bipolar disorder; it is licensed for the prevention of recurrence in patients whose manic episode has responded to ____________ therapy.
Olanzapine
olanzapine
When discontinuing antipsychotic drugs, the dose should be reduced gradually over at least ____________ to minimise the risk of recurrence
4 weeks
What is the role of benzodiazepines in the treatment of bipolar disorder?
May be helpful in the initial stages of treatment for behavioral disturbance or agitation BUT should not be used for long periods because of the risk of dependence
What is the role of lithium in the treatment of bipolar disorder?
- Treatment of acute episodes of mania or hypomania
- Long-term management to prevent recurrence of acute episodes (decision to give prophylactic lithium must be based on careful consideration of the likelihood of recurrence in the individual patient, and the benefit of treatment weighed against the risks)
In the treatment of bipolar disorder, the full prophylactic effect of lithium may not occur for _____________ after the initiation of therapy.
six to twelve months
What is the role of valproate in the management of bipolar disorder?
- Acute manic (but not hypomanic) episodes if lithium is not tolerated or contra-indicated
- Long-term management to prevent recurrence of acute episodes in combination with lithium if treatment with lithium alone is ineffective OR as monotherapy if lithium is contra-indicated or not tolerated
What is the role of carbamazepine in the treatment of bipolar disorder?
Long-term management to prevent recurrence of acute episodes in patients unresponsive to therapy
(Not used to treat acute episodes of mania or hypomania)
Which drugs can be used in the long-term management of bipolar disorder to prevent recurrence of acute episodes? (4)
First line:
- Lithium
Second line:
- Valproate
- Carbamazepine
- Olanzapine
Which drugs can be used in the treatment of acute episodes of mania associated with bipolar disorder? (4)
- Antipsychotics (haloperidol, olanzapine, quetiapine, and risperidone, asenapine)
- Benzodiazepines
- Lithium
- Valproate
What are the contraindications to using lithium? (7)
- Addison’s disease
- Cardiac disease associated with rhythm disorders
- Cardiac insufficiency
- Dehydration
- Family or personal history of Brugada syndrome
- Low salt diets
- Untreated hypothyroidism
Long-term use of lithium has been associated with __________ disorders and mild ___________ and ____________ impairment.
thyroid
cognitive
memory