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Flashcards in Bipolar Deck (20):
1

For mania what are the treatment guidelines

 

  1. Two or three drug combinations
    1. Lithium 
    2. VPA
    3. SGA
  2. + BZD =- Antipsychotic 
  3. Dont combine antipsychotics together
  4. Alternatives CBZ then Oxcarbazepine

If these dont work use three drug therapy 

  • Lithium + Anticonvulsant + AP
  • Anticonvulsant + Anticonvulsant + AP

Last is ECT

2

Non pharm treatment for bipolar disorder?

  • Psychotherapy
  • Support group
  • ECT

3

In a rapid cycler what meds can be used?

  • Valproic acid is preferred
  • Alternatives Carbamazepine, Lamotrigine, Combo therapies 

4

Some is classified as being Bipolar 1 if? 

They have had a manic episode

 

5

What are some medical conditions that can cause mania or hypomania?

  • Alzheimers 
  • AIDS
  • Epilepsy (temporal lobe)
  • Hemodialysis
  • Hyperthyroidism 
  • Neurosyphillis
  • Surgical trauma
  • Post-concussion/head injury
  • CVA
  • Postinfection

 

6

Signs a symptoms of Severe mania

 

  • Often resembles paranoid schizophrenia
  • Bizarra behavior 
  • Hallucinations 
  • Delusions 
  • About 2/3 of pts will have psychotic symptoms 
  • This gets better over time and Schizo wont 

 

7

Signs a symptoms of Mania DigFast 

  • Distractibility 
  • Insomnia (Decrease need for sleep)
  • Grandiosity
  • Flight of ideas
  • Activity 
  • Speech
  • Thoughtlessness

 

8

Hypomania can last for?

4 weeks or longer 

 

9

What are the nonpsychiatric causes of Bipolar disorder?

  • Alcohol, illicit drugs 
  • Anticholinergics 
  • Antidepressants (Dont give them antidepressants alone)
  • Levodopa
  • Thyroid supplementation
  • Zidovudine 
  • Drug withdrawals 
    • Antidepressants 
    • Benzos
    • Corticosteroids
    • Mehtyldopa
  • ECT
  •  

10

Therapy for hypomania

  1. Monotherapy
    1. Lithium
    2. VPA
    3. CBZ
    4. SGA
  2. Can add benzos short term
  3. Alternative can be Oxcarbazepine

2 line combination therapy

  1. Lithium + Anticonvulsant or SGA
  2. Anticonvulsant or SGA

 

11

Some is classified as bipolar II if they have?

Not had a manic episode but have had hypomania 

 

12

The age of onset for bipolar disorder?

18-44 but most people are diagnosed at when they are less than 30 

13

Severe Mania treatment 

  1. Mood stabalizer 
    1. Lithium
    2. Quetiapine or Lurasidone 
  2. Alternative, Lamotrigine, Fluoxetine/Olanzepine combo
  3. If psychosis is present as AP

If that doesnt work consider adding antidepressant or use carbamazepine 

3rd line Lithium + lamotrigine + antidepressant 

or lithium + quetiapine + antidepressant 

Lastly use ECT

14

Hypomanic episode?

Increased energy but doesnt effect your daily function. 

15

Mania can last for about? Or longer 

1 week or longer 

 

16

Untreated episodes can last for?

several months 3-6

 

17

There are many complications of bipolar disorder what are they?

 

  • The suicide success rate is very high
  • Prevalence of substance abuse 
  • Risky sexual practices 

 

18

What are the treament goals for Bipolar disorder?

  • Treat target symptoms of bipolar
  • Prevent relapse 
  • Prevent suicide
  • Minimize adverse events and DI
  • Improve QOL
  • Medication adherence

 

19

A rapid cylcler is classified as?

Someone who has 4 or more manic or depressive episodes 

 

20

Manic depression?

Effects daily function, often end up in jail or the hospital