Bipolar Flashcards
(24 cards)
What does CANMAT mean when it indicates something is a monotherapy?
That the agent has evidence for use as either a sole medication or as an adjunctive agent on a therapy that has already shown effect
Meaning of a adjunctive medication via CANMAT?
Only to be used in combo with a proven monotherapy or therapy combination that has been tested
Bipolar disorder is most commonly misdiagnosed as what?
MDD due to prevelance of depressive episodes in patients with BP. Patients also have difficulty remembering mania episodes
Is suicide risk increased in BP?
YES! one of the leading causes of death in patients with BP
What might indicate bipolar vs a unipolar disease?
Weight gain is more common vs weight loss
Hypersomnia and increased daytime napping, we see decreased sleep in early unipolar
Bipolar arises earlier (<25YO) and multiple previous occurances more likely
First line adjunctive non-pharm therapy for BP?
Psychoeducation
How long does someone have to be in a manic state to meet DSM criteria for mania?
1 full week of persistant symptoms of abnormal mood increased activity or other mania presentation
Mania episode definition?
3 (or 4 days if only “irritable”)
Following symptoms: inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure of speech, increased goal directed activiyy, agitation, increased involvment in actiivity with high risk of painful consequences (thrill seeking I guess?)
what is akathesia commonly misstaken for?
Agitation, need to be careful about this when determining a patients mood state
First line agent for mania episode treatment? (short term)
Aripiprazole, lorazepam, loxapine, olanzipine
All as IM formuatlion except loxapine which is inhaled
Oral agents that are second line for mania episode? (short term)
Aresenipine (sublinual) and risperidone (ODT)
Time to improve in mania symptoms?
3-4 weeks of treatment
3 first line agents with good evidence for maintenance of prevention of any mood episode
Lithium, Quetipine, divalproex
First line combination therapies?
Everything is Li or DVP +
Quetiapine, aripiprazole, risperidone, asenapine
Aripiprazole has negative evidence for acute treatment of what?
for use in depression acute treatment
Haloperidol has level 4 negative evidence for what?
Second line as combination therapy for depression prevention
Therapies with the highest safety concerns according to CANMAT
Quetiapine (in combination with DVP or Li), risperidone (in combination with DVP or Li), olanzapine(mono or combo), haloperidol
Agents that are not recommended to be used in combination?
Ziprasidone, paliperidone
Tamofoxifen level of evidence and place in therapy?
Third line, secondary level of evidence and used as monotherapy or combo with lithium or DVP
What is rapid cycling?
4 or more mood episodes per year
Which agent is first line for treatment of depression episode and for maintence but has negative evidence for acute mania?
Lamotrigine
Medications to use when a rapid response is required?
Quetiapine and lurasparidone have shown superiority over placebo after 1 week
When would you want to provide a rapid medication?
Suicide risk, medical complication such as dehydration
distinguish the difference between bipolar I and bipolar II
what is the difference between mania and hypomania?
Bipolar I: Lifetime history of at least 1 clear-cut manic episode with or without episodes of hypomania or depression
Bipolar II: hypomanic + major depressive episodes + no history of manic episodes
hypomania is similar to mania but episode is not severe enough to cause marked social impairment, no psychotic features and lasting at least 4 days consecutive days and present most of each days
