Pharmacotherapy of Bipolar Disorders Flashcards
1
Q
Bipolar Disorders
A
- Bipolar I Disorder: Mania (and usually major depression)
- Bipolar II Disorder: Hypomania and Major Depression
- Cyclothymic Disorder: subthreshold hypomania and subthreshold depression
- Substance/Medication Induced Bipolar Disorder
- Bipolar Disorder due to another medical condition
2
Q
Mania
A
- Distinct period
- Abnormal and persistent
- Elevated, expansive, or irritable mood
- Increased activity or energy
- 1 Week (or any duration if hospitalization needed)
- Most of the day nearly every day
3
Q
Mania Symptoms
A
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual/pressured speech
- Flight of ideas/racing thoughts
- Distractability
- Increased goal directed activity
- Excessive involvement in high risk activity: buying sprees, sex, foolish investments
- Marked impairment or hospitalization or psychosis
- Exclude other causes
4
Q
Hypomania
A
Mania Criteria Except
- 4 days
- Unequivocal change in functioning
- Observable by others
- Not severe enough to cause impairment or hospitalization
- No psychosis
5
Q
Specifiers
A
- Rapid Cycling: 4 or more distinct mood episodes per year
- Mixed Features: presence of depressive symptoms in mania or vice versa
- With Psychotic Fetures
- With Anxious Distress
- Seasonal Pattern
- Peripartum Onset
6
Q
Screening for Bipolar Disorders
A
- MDQ >= 7 (Sensitivity 58%, Specificity 93%)
- Self Report Scale
- > =7 symptoms occuring at same time
- Moderate or serious
7
Q
Acute Phase Treatment Goals
A
- 1-3 months
- Non-response: <25% reduction in symptoms
- Partial Response: 25-50% reduction in symptoms
- Response: >50% reduction in symptoms
- Remission: Absence of mood symptoms for over 2 months
8
Q
Maintenance Phase Treatment Goals
A
- 3 months - lifetime
- Prevent relapse to any mood episode
9
Q
Bipolar Disorder Treatments
A
- Bipolar Mania: Medication SMD 0.42
- Bipolar Depression: Medication SMD 0.24
- Bipolar Maintenance: Medication SMD 0.41
- Psychotherapy: not for monotherapy, possibly effective for augmentation
10
Q
First Generation Antipsychotics (D2 Antagonist)
A
- High Potency: Haloperidol*, Fluphenazine
- Mid Potency: Perphenazine
- Low Potency: Chlorpromazine, Thioridazine*
11
Q
Second Generation Antipsychotics (D2/5HT2 Antagonist)
A
- High Potency: Risperidone, Olanzapine, Asenapine, Paliperidone, Iloperidone
- Mid Potency: Ziprasidone*, Lurasidone
- Low Potency: Quetiapine, Clozapine
12
Q
Second Generation Antipsychotics (D2 Partial Agonist/5HT2 Antagonist)
A
- Aripiprazole
- Brexpiprazole
- Cariprazine
13
Q
Theories of Atypicality
A
- Minimal Neuroleptic Potential: Clozapine, Quetiapine
- 5HT2 Antagonism/D2 Disinhibition: all second generation
- Fast Off/Kiss-and-Go: Clozapine, Quetiapine, Olanzapine
- D2 Partial Agonism: Aripiprazole, Brexpiprazole, Cariprazine
14
Q
Antiepileptics
A
- Valproic Acid/Divalproex 25-60 mg/kg/day
- Carbamazepine 400-800 mg PO BID
- Lamotrigine 200 mg PO QD
Monitoring
- Baseline: CBC, Chem7, LFTs, lipase, HCG
- Follow-up: Troughs and the baselines
15
Q
Lithium
A
- 900-1800 mg/day
- Conduction blocks, delirium, ataxia, coma, seizures, death at toxicity
Monitoring
- Baseline: Chem7, Ca+, TSH, HCG
- Follow-up: Baselines and trough levels
