Mental Health 2 Flashcards
What is Bipolar disorder?
Characterised by periods of high mood (mania) and low moods (depression)
What is Bipolar I?
at least one manic episode with or without history of major depressive episodes
What is bipolar II?
one or more major depressive episodes, and at least one hypomanic episode, but no evidence of mania
DSM criteria for mania?
- abnormally and persistently elevated, expansive or irritable mood lasting 1 week
- accompanied by at least 3 of: increased energy/activity, pressure of/incomprehensible speech, flight of ideas, poor concentration, disinhibition, extravagant/impractical plans, delusions or hallucinations
- severe enough to cause marked impairment in social/occupational funcitoning or require hospitalisation or includes psychotic features
WHat is hypomania?
similar to mania, but symptoms only need to have lasted for 4 days, not severe enough to cause marked impairment/hospitalisation, and no psychotic features
How to treat mania?
- consider stopping any antidepressants
- if on mood stabiliser, maximise dose
- use antipsychotics - Haloperidol, Risperidone, Olanzapine, Quetiapine (if ineffective or not tolerated switch)
- if only on antipsychotic and still insufficient response, consider adding lithium or valproate
- do not use lamotrigine for mania
Why is suddenly stopping antidepressants in mania recommended by NICE?
Discontinuation symptoms are better than antidepressants adding to mania
How to treat bipolar depression?
- maximise mood stabiliser dose if on one
- Fluoxetine and Olanzapine, or Quetiapine
- Can also consider – Olanzapine on its own, or Lamotrigine
- If no response to Fluoxetine and Olanzapine, or Quetiapine, use Lamotrigine
What are the treatments for maintenance of bipolar disorder?
- lithium is the gold standard
- other options: add/switch to valproate or olanzapine, or quetiapine if used in acute phases
- some patients can go without medication if they are willing to seek help asap when episodes occur
Important to note when prescribing/dispensing lithium?
Brand specific, not interchangeable
Biological effects of lithium?
- 4-7 days to reach steady state, narrow therapeutic range
- levels should be 0.4-0.8mmol/l 12 hours post dose
Monitoring requirements for lithium?
- check lithium levels weekly until stable, then every three months
- Baseline and regular monitoring of U&Es, eGFR, TFTs, Bone, FBC, ECG, BMI
Main side effects/risks with lithium?
- toxicity. signs: vomiting and diarrhoea, coarse tremor, CNS disturbances
- side effects: fine tremor, acneiform eruptions
- nephrotoxicity, hypothyroidism, hypercalcaemia
- hydration important
Drug interactions with lithium?
NSAIDs, diuretics, ACE inhibitors
What are the counselling points for patients taking lithium?
- Indication, dose, time of dose, frequency
- Brand, MR formulation
- Duration of treatment
- Physical and lithium monitoring
- Why we do monitoring, when we do levels, frequency
- Side effects
- Causes of toxicity – dehydration, changes to salt, other medicines
- Signs of toxicity
- What to do if toxicity occurs
- Drug interactions – only buy OTC medicines from a pharmacy, tell pharmacist that you are taking Lithium.
- Pregnancy
Forms of valproate available?
Sodium valproate or semisodium valproate
Monitoring requirements for valproate?
Baseline and regular BMI, FBC, LFTs – after 6 months, then annually
Purpose of monitoring for valproate?
Check adherence, effect and toxicity
Who is valproate not suitable for and why?
Females of child bearing potential
Huge risk of teratogenic effects - malformations, developmental disorders, autism, ADHD
What is the treatment pathway for BPAD?
- treat acute episodes
- review medication once there is improvement
- back to baseline
- maintenance treatment
- minimum amount and dose of medication
Role of the pharmacist in bipolar treatment?
- medicines reconciliation
- medication options
- counselling and discussion with patient
- monitoring compliance
- Advcie: interactions, pregnancy, complications of treatment
- Side effect and monitoring advice
- recognising toxicity
- reviewing treatment
- recognising relapse
When does anxiety become a disorder?
When it has an impact on the individual’s day to day life
Examples of anxiety disorders?
GAD, social anxiety disorder, panic disorders, PTSD, OCD
What therapy can be used to treat anxiety disorders?
CBT - change thinking patterns