Bipolar and related disorders Flashcards
(97 cards)
1
Q
What is the 1st line treatment option in bipolar disorders?
A
Lithium
2
Q
What is the dose of lithium as a mood stabiliser according to?
A
Trough level of lithium in the blood
3
Q
What is a safe lithium starting dose?
A
500mg po mane
4
Q
Lithium has a very wide/narrow therapeutic index
A
Narrow
5
Q
How often should lithium levels be checked?
A
4 days after treatment start/change
Every 6 months
6
Q
What does it mean that lithium blood levels are trough levels?
A
Blood must be drawn right before the next dose
7
Q
Give side effects of lithium
A
Nausea Vomiting Diarrhoea Postural tremor Polyuria w/ polydipsia Hypokalemia Nonspecific interstitial fibrosis (>10y) Hypothyroidism Hyperthyroidism Teratogenesis
8
Q
Give thyroid side effects of hyperthyroidism
A
Goiter
Expothalmos
9
Q
Give cardiac side effects of hypokalemia
A
T wave flattening/inversion
Sinus dysrythmias
Heart block
Syncope epipsodes
10
Q
What is the teratogenic result of lithium use?
A
Ebstein’s anomaly
11
Q
Give signs of lithium toxicity
A
Tremor Dysarthria Ataxia N+V Diarrhoea CVS changes Renal dysfunction Myoclonus Muscular fasciculations Seizures Impaired LOC Coma
12
Q
Which investigations should be performed before a patient begins lithium treatment?
A
UKE Creatinine clearance FBC TSH Beta-hcg ECG
13
Q
Why check UKE when starting lithium treatment?
A
Potassium levels
Kidney dysfunction
14
Q
Why check creatinine clearance when starting lithium treatment?
A
Kidney excretion required
15
Q
Why check FBC when starting lithium treatment?
A
Lithium causes leucocytosis
16
Q
Why check TSH when starting lithium treatment?
A
Lithium interferes with thyroid function
17
Q
Why check beta-hcg when starting lithium treatment?
A
Lithium is teratogenic
18
Q
Why check ECG when starting lithium treatment?
A
Check for dysrhythmia
Check for heart block
19
Q
What is the advantage of valproate in 1st line treatment?
A
Able to titrate dose upwards rapidly
20
Q
What is the dose of valproate for bipolar disorders?
A
250-1250mg po bd
21
Q
Name common side effects of valproate
A
Sedation Weight gain Thrombocytopenia Hair loss Tremor PCOS Teratogenesis
22
Q
What is the teratogenic result of valproate?
A
Neural tube defects
23
Q
Which investigations should be performed before a patient begins valproate treatment?
A
LFTs
Beta-hcg
Pelvic sonar
24
Q
What is the dose of carbamazepine in bipolar disorders?
A
Start 200mg po bd
Titrate 200mg at a time
Maintenance 600-800mg po bd
25
Name common side effects of carbamazepine
```
Exfoliative dermatitis
Hyponatermia
SIADH
GIT S/E
Hepatitis
Agranulocytosis
Teratogenesis
Drug metabolism interference
```
26
Which investigations should be performed before a patient begins carbamazepine treatment?
LFTs
UKE
FBC
Beta-hcg
27
What is the teratogenic effect of carbamazepine?
Neural tube defects
28
Why check LFTs when starting valproate treatment
Liver metabolism of valproate
29
Why check LFTs when starting carbamazapine treatment
Liver metabolism of carbamazepine
30
Why check UKE when starting carbamazepine treatment
Hyponatremia
| SIADH
31
Which medication is effective in treating bipolar depression?
Lamotrigine
32
Lamotrigine is useful in preventing manic episodes and treating manic episodes
True or false?
False
| Not effective in treatment of manic episodes
33
What is the dose of lamotrigine in bipolar disorders?
Start 25mg po nocte
Titrate 25mg every 2 weeks
Maintence 100-200mg po nocte
34
What risk is there when titrating lamotrigine too rapidly?
Steven-Johnson syndrome
35
Name common side effects of lamotrigine
```
Dizziness
Ataxia
Blurred vision
Diplopia
Headache
Sedation
N+V
SJS
```
36
What do you do in a patient who has started lamotrigine and begun developing a rash?
IMMEDIATELY STOP LAMOTRIGINE
37
Which atypical antipsychotics can be used in the treatment of bipolar disorder?
Olanzapine 10-20mg po nocte
Quetiapine 300-800mg po nocte
Aripriprazole 10-30mg po nocte
38
Name a common side effect of atypical antipscyhotics
Metabolic syndrome
39
Name common side effects of olanzapine
```
Severe MS
Sedation
Dizziness
Dry mouth
Consstipation
Dyspepsia
Akathisia
```
40
Name common side effects of quetiapine
MS
Sever sedation
Dizziness
Postural hypotension
41
Name common side effects of aripriprazole
```
Headache
Sedation
Akathisia
Agitation
Anxiety
Dyspesia
Nausea
```
42
What is NOT a side effect of aripriprazole that is a side effect of olanzapine and quietapine?
MS
43
What should be monitored in a patient on an atypical antipsychotic?
```
Fasting glucose
Lipogram
BP
WC
Weight
```
44
Name atypical bipolar features
Hypersomnia
Weight gain
Sensitive interpersonal communication
Leaden paralysis
45
Define rapid cycling
At least 4 distinctive episodes within 1 year
46
Which drug class can result in mania in bipolar disorder?
Antidepressants
47
Name specifiers in a current/most recent bipolar disorder episode
```
Mild, moderate, severe
W/ anxious distress
W/ mixed features
W/ melancholic features
W/ atypical features
W/ psychotic features (mood congruent/incongruent)
W/ catatonia
W/ peripartum onset
```
48
Name lifetime pattern specifiers in bipolar disorder
W/ rapid cycling
W/ seasonal pattern
In partial remission
In full remission
49
Give the aetiology of bipolar disorder
Multifactorial
Biological
Genetic
Psychosocial
50
Which bipolar disorder patients should be hospitalised?
Risk of suicide
Risk of homicide
Relapse w/ grossly impaired ability food/shelter in absence of proper support system
Rapidly progressing symptoms
51
Which bipolar disorder patients are usually hospitalised?
Manic episodes
Severe depressive episodes
Mixed features
52
Which bipolar disorder patients usually receive outpatient treatment?
Hypomanic
| Mild-moderately severe depressive episodes
53
Psycotherapy and pharmcotherapy in bipolar disorder are more effective when used alone/in combination
In combination
54
During which phases and episodes is psychotherapy useful?
Maintenance phase
Hypomania
Mild-moderate depression
55
During which episodes is psychotherapy unuseful?
Manic
Severe depressive
Psychotic
Mixed features
56
What is the psychotherapy treatment of choice in bipolar disorder?
Cognitive behavioural therapy
57
Which drug class is the mainstay of bipolar disorder pharmacotherapy treatment?
Mood stabilisers
58
Combination mood stabilisers in severe bipolar pathology is unusual
True or false?
False
59
Name the 4 domains of mood stabiliser
Treat from above
Stabilise from above
Treat from below
Stabilise from below
60
Which domain of mood stabiliser does manic episode treatment follow?
Treat from above
61
Which domain of mood stabiliser does manic episode prevention follow?
Stabilise from above
62
Which domain of mood stabiliser does depressive episode treatment follow?
Treat from below
63
Which domain of mood stabiliser does depressive episode prevention follow?
Stabilise from below
64
Why avoid antidepressants in bipolar disorder management?
Hypomania risk
| Rapid cycling risk
65
Name mood stabilisers effective in treating depression in bipolar disorder
```
Lamotrigine
Olanzepine
Quetiapine
Aripiprazole
Lithium
Valproate
```
66
Which mood stabiliser is best in severe depression requiring urgent treatment and why?
Quetiapine (quicker onset of action)
67
Why is lamotrigine started slowly?
Side effect profile
| SJS
68
What do you always need to give antidepressants in bipolar disorder?
In combination with at least 1 mood stabiliser
- 1 effective in treating depression
- 1 effective at preventing manic episodes
69
Discuss management of psychotic depression in bipolar disorder
Add an antipsychotic
Use atypical antipsychotic
Avoid haloperidol
70
Why avoid haloperidol in psychotic depression of bipolar disorder
Causes dysphoria
71
Which antipsychotics are best for psychotic depression in bipolar disorder
Olanzapine
Quetiapine
Aripiprazole
72
Discuss treatment of a manic episode
1. Start mood stabiliser for mania
2. Add antipsychotic if needed
3. Add long acting BZD if needed
4. ECT if needed
5. Stop antidepressants
6. Sedate in emergency if needed
73
Name mood stabilisers effective in treating mania
Valproate
Lithium
Atypical antipsychotic
74
Name the advantage of valproate in the manic episode
Can titrate dose upwards rapidly
75
Name the disadvantage of lithium in the manic episode
Slow titration due to toxicity risk
76
Which antipsychotics are effective in a manic episode for psychosis?
```
Haloperidol
Atypical antipsychotic (olanzepine)
```
77
Which BZD is effective in a manic episode if needed?
Clonazepam 2mg po tds
78
Give examples of emergency sedation options in treatment of a manic episode
```
Lorazepam
Haloperidol
Olanzapine
Ziprasidone
Clopixol acuphase
```
79
Which medication MUST be stopped during a manic episode?
Antidepressant
80
Discuss treatment of a hypomanic episode
1. Start mood stabiliser for mania
2. Add antipsychotic if needed
3. Add long acting BZD if needed
4. Stop antidepressants
81
Which antipsychotics are effective in a hypomanic episode for psychosis?
Haloperidol
Atypical antipsychotic
UNUSUAL AS IMPLIES MANIC
82
Which BZD is effective in a hypomanic episode if needed?
Clonazepam 2mg po tds
| UNUSUAL AS IMPLIES MANIC
83
Discuss treatment of mixed features
1. Start mood stabiliser
| 2. Add antipsychotic if needed
84
Which mood stabilisers are effective in treating mixed features?
Valproate
Lamotrigine
Consider atypical antipsychotic
85
What is the issue with valproate and lamotrigine combined?
Lamotrigine metabolised by CYP450 in liver -> valproate ihibits the CY450 -> incr serum lamotrigine -> SJS risk increases
86
What medications are used for the maintenance phase of bipolar disorder?
Lithium
Valproate
Carbamazepine/oxcarbazepine
Lamotrigine
87
What is lithium most effective in treating and preventing?
Manic episodes
88
What is valproate most effective in treating and preventing?
Manic episodes
89
What is valproate the treatment of choice for?
Mixed features
| Rapid cycling
90
Is valproate effective in treatment and prevention of depression?
NO
91
Why is carbamazepine no longer routinely used?
Same use profile as valproate
| Less effective
92
What is lamotrigine the treatment of choice for?
Preventing depressive episodes
93
What is lamotrigine effective in treating?
Depressive episodes treatment
| Manic episode prevention
94
Which episodes is lamotrigine not effective in?
Treatment of manic episodes
95
What are atypical antipsychotics not effective in?
Preventing depressive episodes
96
Name medications claimed to have efficacy but mostly ineffective as mood stabilisers
```
Topiramate
Gabapentin
Levetiracetam
Pregabalin
Riluzole
Memantine
Ketamine
Amantadine
CCBs
```
97
What are atypical antipsychotics effective in treating?
Treating manic episodes
Preventing manic episodes
Treating depressive episodes
