NS: Mania and hypomania Flashcards
Long-term treatment of bipolar disorder should continue for at least how long from the last manic episode?
Two years
Long-term treatment of bipolar disorder should consider for at least how long from the last manic episode (risk factors for relapse present)?
five years
An antidepressant drug may be required for the treatment of co-existing depression in mania/hypomania but should be avoided in what patients?
Rapid-cycling bipolar disorder.
Recent history or hypomania.
Rapid mood flucuations
What is the place of BZ’s in the management of mania/hypomania?
May be helpful in the initial stages for treatment for behavioural disturbance or agitation; they should not be used for long periods because of the risk of dependence.
Antipsychotic drugs (normally olanzapine, quetiapine or risperidone) are useful in acute episodes of mania and hypomania; if the response to antipsychotics is inadequate what can be added?
Lithium or valproate.
Asenapine is licensed for the treatment of moderate to severe manic episodes associated with bipolar disorder. What generation is it?
A second-generation antipsychotic.
When discontinuing antipsychotics, the dose should be reduced gradually over at least 4 weeks if the patient is continuing with other antimanic drugs; if the patient is not continuing with other antimanic drugs or if there is a history of manic relapse, a withdrawal period of up to how long should be considered?
up to 3 months
What antiepileptic drug may be used under specialist supervision for the prophylaxis of bipolar disorder (manic-dpressive disorder) in patients unresponsive to a combination of other prophylactic drugs?
Carbamazepine.
It is used in patients with rapid-cycling manic-depressive illness (4 or more affective episodes per year).
The dose of carbamazepine should not normally be increased if an acute episode of mania occurs.
What drugs which should not be used in women of child bearing age, unless alternative treatments are ineffective, can be used for both the treatment of manic episodes of bipolar AND the prophylaxis of bipolar disorder?
Valproic acid and sodium valproate.
If a patient taking valproate experiences an acute episode of mania that is not ameliorated by increasing the valproate dose, concomitant therapy with one of what three drugs should be considered?
Olanzapine
Quetiapine
Risperidone
In the prophylaxis of bipolar episodes, the full prophylactic effect of lithium may not occur for how long?
6-12 months after the initiation of therapy.
