Wk 27 - Bipolar disorder Flashcards
What is bipolar disorder?
Occurence of 1 or more manic episodes, followed by episodes of major depressive disorder
What is Bipolar I?
At least 1 manic or mixed episode
What is Bipolar II?
At least 1 major depressive episode plus 1 milder manic syndrome (hypomanic episode)
What is cyclothymic disorder?
Alteration in mood btw hypomania + mild depression
What is bipolar characterised by?
- Elevated or irritable mood for > 1wk
- Impairment + at least 4:
- Distractibility
- Grandiosity
- Inc talking
- Reckless behaviour
- Racing thoughts
- Inc activity
- Dec need to sleep
What are the key features of mania?
- Elevated
- Irritable mood
- Marked impairment in functioning
What are the key features of hypomania?
- Elevated, expansive or irritable mood
- No psychotic symptoms
- Less impairment of functioning
What are the key features of depression?
- Mild, mod or severe
- W/ or w/o psychotic symptoms
What are the key features of rapid cycling?
4 episodes in a year
When is the usual onset of bipolar disorder?
15 - 19 years
Which race has a higher incidence of bipolar disorder?
Black + other minority ethnic groups
What is the first choice for acute mania phase?
- Lithium
- Atypical antipsychotics
- Semisodium valproate
What is the second line for acute mania phase?
- Benzodiazepines
- Carbamazepine
What is the first choice for maintenance treatment of bipolar disorder?
- Lithium
- Carbamazepine
- Semisodium valproate
- Atypical antipsychotics
When is an electrocardiogram offered to a patient?
- Physical examination identified a specific CVD risk
- Fam history of CV disease + sudden collapse
- CVD risk factors: cardiac arrhythmias
- Inpatient
What should be monitored when on antipsychotics?
- Pulse + BP after dose change
- Weight + BMI weekly for 1st 6wks then 12 wks
- Blood glucose/Hba1c + blood lipid profile at 12 wks
- S/e
- Emergence of movement disorder
- Adherence
Can you start combined antipsychotics?
No unless for ST
When stopping, how many weeks is needed to reduce the dose?
4 wks to minimise risk of relapse
What is lithium?
- Mimic role of Na in excitable tissue
- Penetrates voltage gated Na channel responsible for action potential generation
- Not pumped out by Na/K ATPase
- Interferes w/ phosphatidylinositol pathways + negatively affect hormone induced cAMP prod
What are the pharmacokinetics of lithium?
- Oral admin
- Narrow therapeutic index
- Not prescribed unless monitoring available
- Sample taken 12 hrs after dose to achieve serum-lithium conc 0.4-1 mmol/L
- Peak serum 3-5hrs
- Several days to reach steady state
What are the laboratory measurement of lithium?
- Serum levels checked after 5-7 days of initial prescription dose
- Once dose established, check every 4 wks then 3 months
- 5ml venous blood
- Timing of collection = vital for accurate interpretation of routine therapeutic monitoring
- Blood sampled 12 hrs after last dose
What are the adverse effects of lithium?
- Dyspepsia
- ECG changes
- Polyuria + dipsia
- Oedema
- Tremor
- Muscle weakness
- Neutrophilia
What are the counselling points of lithium?
- Maintain fluid intake + avoid dietary changes relating to sodium intake
- Minimal alcohol consumption
- Brand prescribe, monitor if changed
- Don’t take NSAIDs
- Hypothyroidism: lethargy, cold, weight gain = referral
- Fluid loss from di + vom = discontinue
- Monitor renal + thyroid on initiation + every 6 months
What are the contraindications of lithium?
- Dehydration
- Untreated hypothyroidism
