Psychiatric conditions: Bipolar Disorder

Question 1

Bipolar I

Answer 1

At least one episode of mani, usually bouts of intense depression

Question 2

Bipolar II

Answer 2

at least one episode of hypomania (lasting > 4 consecutive days) and atleast one depressive episode (lasting > 2 weeks)

Hypomania doesn’t affect social/work functioning, doesnt cause psychosis or req hospitalization

Question 3

Bipolar Depression

Answer 3

predominant symptoms of a depressive episode

Question 4

Psychosis

Answer 4

severe mental conditions where there is a loss of contact with reality, involves abrnoal thinking and perception

Question 5

Symptoms of Mania

Answer 5

inflated self-esteem
need less sleep
more talkative than normal
jumping form topic to topic
easily distracted
inc in goal-directed activity
high risk, pleasurable activities = buying spree, sexual indiscretions, gambling

Question 6

Traditional mood stabilizers

Answer 6

lithium

anti epileptics ( valproate, lamotrigine and carbamazepine)

Question 7

Manic episode 1st line txm

Answer 7

antipsychotic (olanzapine/risperidone), lithium or valproate

combo of anti psych + mood stabilizers for severe episodes

Question 8

Depressive episode 1st line txm

Answer 8

antipsychotic (quetiapine, lurasidone), can add lithium, valproate or lamotrigine

Question 9

Why does lamotrigine require short titration

Answer 9

due to risk of severe rash developing

should not be used for acute mania

Question 10

Common SGA used in bipolar disorder

Answer 10

Aripiprazole = Abilify
Olanzapine = Zyprexa
Risperidone = Risperdal
Quetiapine = Seroquel
Ziprasidone = Geodan

Lurasidone = Latuda
Olanzapine/Fluoxetine = Symbyax = can be used alone for acute depressive episodes

Question 11

Therapeutic range for Lithium in Bipolar disoder

Answer 11

0.6 - 1.2 mEq trough lvl

acute mania can req 1.5 mEq/L initially

Question 12

Lithium (Lithobid) boxed warning

Answer 12

monitor serum lvls to avoid toxicity

Question 13

Litium (Lithobid) warnings

Answer 13

Renal impairment
serotonin syndrome

Question 14

Lithium (Lithobid) side effects within therapeutic range

Answer 14

GI upset
cognitive effects
cogwheel rigidity
fine hand tremor
thirst
polyuria
polydipsia
weight gain
hypothyroidism

Question 15

Lithium (Lithobid) toxicity

Answer 15

> 1.5 mEq/L ataxia, coarse hand tremor, vomiting, persistant diarrhea, confusion, sedation

> 2.5 mEq/L CNS depression, arrhythmia, seizure, coma

Question 16

Lithium (Lithobid) monitoring

Answer 16

lithium lvls
renal function
thyroid function

Question 17

Lithium (Lithobid) notes

Answer 17

avoid in pregnancy
renally cleared

Question 18

Lithium drug interactions

Answer 18

lvl inc with dec salt intake, sodium loss
use aspirin and sulindac in place of NSAIDs

lvl dec with inc salt intake, caffeine, theophylline

Question 19

Mood stabilizers in pregnancy

Answer 19

Lamotrgine is safer option of the mood stabilizers

Lurasidone preferred but only approved for bipolar depression

Valproate, Lithium and Carbamazepine cause issues with baby