Module 5: Bipolar Flashcards
When does bipolar s/s begin
Patients usually present with episode of depression initially, as mania is often enjoyed by patients.
S/S develop late teens early 20’s
Causes of bipolar
Deficit of serotonin and fluctuation of NE levels
Bipolar 1
Manic episodes that last at least 7 days or mania that requires hospitalization
usually person has depressive episodes lasting at least two weeks
Bipolar 2
Hypomanic episodes fluctuating with depressive episodes
Cyclothymic disorder
mild form of bipolar but s/s for 2+ years and does not meet full requirements
Bipolar 1 diagnosis
At least 1 week of symptoms of mania
must include either:
1. abnormally elevated mood or..
2. irritability
Also must include 3+ other s/s
-inflated self-esteem
-decrease need for sleep
-increased talking
-racing thoughts
-distractability
-excessive extroversion
Acute mania treatment:
lithium
Valproic acid
antipsychotic (Quetiapine)
What drugs are not recommended for acute mania
Gabapentin, topamax, lamotrigine, olanzapine
Hypomania
Must persist for at least 4 days
same criteria as mania however not as severe enough to cause impairment in social or occupational functioning
Bipolar depression
More than 2 weeks of:
depressed mood/loss of interest
+ 4 other s/s of depression
_____% of patients are misdiagnosed with unipolar depression
60%
Maintenance medication therapy for bipolar disorder
First line: 2nd generation antipsychotics (ex quetiapine), lithium, lamotrigine
can do combo therapy with atypical antipsychotic + lithium or divalproex
*Fluoxetine is the only antidepressant that can be considered for bipolar depression, however CAREFUL consideration must be done as it can cause increase in mania – usually not recommended
Do not give lithium for pt with __________ insufficiency
Renal
Lamotrigine
Helpful only in bipolar depression
MOA: inhibit release of glutamate
watch for: Steven Johnson Syndrome
Watch for toxic epidermal necrolysis
SE: Sedation, drowsy, dizzy, ataxia, HA, nausea, tremor, rash, risk of SI
Dopamine antagonists
Antipsychotics
aripiprazole
clozapine
olanzapine
quetiapien
risperidone
(decreases dopamine transmission)
Pregnant and bipolar
Lamotrigine is a good option during pregnancy
(Lithium can cause cardiac malformations)
Elderly and bipolar
Check for medical causes first if new dx
lithium or Valproex or lamotrigine
Atypical antipsychotics have a black box warning for increase sudden death/CVA in elderly pts (with dementia)
