Bipolar and Cyclical Mood Disorder Tx Flashcards Preview

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Flashcards in Bipolar and Cyclical Mood Disorder Tx Deck (24):
1

Lithium or Depakote for mixed state

Depakote > Li for a mixed state

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Cyclothymic Disorder

1. Presence of episodes of hypomanic symptoms and depressive symptoms that do not meet criteria for a major depressive episode for the majority of the time over 2 years with no period of absence of symptoms that lasts more than 2 months

2. During this period, no episodes have met criteria for a major depressive episode, manic episode, or mixed episode.

3. If these develop after the initial 2 year period, the diagnosis of cyclothymic disorder will be retained, in addition to the new diagnosis.

3

Stages of Manic Symptoms

Stage I: Hypomania
Stage II: Acute Mania
Stage III: Delirious Mania

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Stage I: Hypomania

Symptoms not sufficient to require hospitalization or impairment of social or occupational functioning

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Stage II: Acute Mania

Usually requires hospitalization; marked impairment in functioning of mood, cognition, and perception

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Stage III: Delirious Mania

Severe clouding of consciousness and intensified symptoms of acute mania

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Lithium dose range

300-2400 per day

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Lithium not as effective for

depressive states
rapid cyclers
mixed episodes

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Lithium Acute Stabilization Blood Level

0.8 to 1.5 mEq/L

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Lithium prophylaxis/maintenance level

0.6-1.0
Should be hovering around 0.8

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Effect of Lithium on thyroid

Lithium is known to deplete thyroid stores

12

Li: Initial side effects

GI upset
fine hand tremor
Polyuria, polydipsia

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Li: Long-term side effects

Wt gain
Dermatological
Leukocytosis
Hypothyroidism
Diabetes insipidus

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Li toxicity 1.5-2.0 mEq/L

Course tremor, NVD, confusion, ataxia, slurred speech, lethargy--> Hold Li one day and re-evaluate

15

Li Toxicity ≥ 2.0 mEq/L

Profound CNS depression, arrhythmias, szr, coma

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Depakote dosage range

250-1500 mg/day

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Depakote for BPD

Used in addition to LI or sometimes as first-line monotherapy for rapid cyclers, effective for mania more than depression

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Carbamazepine (Tegretol) dosage range and major SEs

200-1600 mg/day
Rash, leukopenia, hepatic dysfunction

19

Lamotrigine dosage range

50-500 mg/day; max 200mg with divalproex sodium (Depakote)

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Lamotrigine Advantage

Best at managing Bipolar depression

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Haldol and Depakote

Mild encephalopathy that can mimic EPS, but it is not EPS

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Dysthymia

2 years of persistently depressed mood
Respond ok to meds
Long delays in seeking treatment
Sx are mild

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MDD + Dysthymia

"Double depression"

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Mixed episode criteria

1. Criteria for both a manic episode and for a major depressive episode are met every day during a 1-week period

2. Mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

3. Sx are not due to the direct physiological effects of a substance or a general medical condition.