Bipolar Disorder Flashcards
Hypomanic
Same symptoms as mania but milder and not disabling; no psychotic symptoms
Duration: 4 days or longer and present most of the day
Manic
Mood: abnornally and peristantly elevated, expansive or itritable; must have concomitant increase in activity or energy; psychotic symptoms may occur
Duration: at least 1 week, present most of the day, causing significant distress/disability or requiring hospitalization
PLUS: grandiosity, more talkative, excess involvement in pleasurable activities that may have unpleasant consequences, less need for sleep, flight of ideas, distractability, more goal directed activity.
Major depressive episode
Mood: Depressed most of the day or markedly diminished interest or pleasure (anhedonia)
Duration: at least 2 weeks with significant change from previous functioning
PLUS (4+): insomnia/hypersomnia, significant weight or appetite change, fatigue/loss of energy, psychomotor retardation or agitation, worthlessness/guilt, impaired thinking/concentration/decision making, recurrent thoughts of death/SI/plan
Bipolar I
Lifetime history if at least 1 clear cut manic episode with or without hypomania or depression
Bipolar II
History of hupomania episode and major depressive episides with not history of full manic episode
Cyclothymic disorder
Recurrent episodes of hypomania and mild (subthreshold) depressive symptoms
Bipolar Goals of Therapy
Control symptoms of acute episode
Prevent recurrences
Provide ancillary care for comorbid psychiatric conditions
Restore optimal functioning and cognition
Non-pharmacology for bipolar
Psychoeducation
CBT or family therapy
“Relapse drill”
Adequate sleep
Key principles for treating cognitive impairment
Attention to treating to full remission Treat concomitant disorders Discontinue offending medications Management of medical comorbidities Wellness routines
Approach to treatment from the 2018 CANMAT guidelines
Balance treatment for acute episodes with knowledge of how the compound works for other phases of the disorder since treatment is often long term. Ex. If choosing between 2 meds with sinilar evidence of efficacy for acute mania where one has better efficacy for maintenance, consider choosing that med
Can antidepressants be used in bipolar disorder?
No, if on antidepressent and acute mania occurs d/c antidepressant
The “gold standard” medication
Lithium - manages bipolar and has aditional anti-suicidal properties that may also possibly reduce thr risk of dementia
Key safety consideration of lithium, divalproex, CBZ, antipsychotics
Lithium: caution in renal disease
Divalproex: caution women of childbearing age due to mentrual irregularities and teratogenic
CBZ: DI and induction of SJS
Antipsychotics: adverse metabolic effects
1st line management of acute mania (in order of preference)
Lithium Quetiapine Divalproex Asenapine Aripiprazole Paliperidone Ridperidone Cariprazine Combination lithium or divalproex plus an AP above
2nd line management of acute mania
Try several 1st line treatments Olanzapine Carbamazepine Lithium or divalproex PLUS olanzapine Lithium AND divalproex Ziprasidone Haloperidol ECT
1st line management of acute depression (in preference order)
Quetiapine (including XR) Lithium or divalproex PLUS lurasidone Lithium Lamotrigine Lurasidone Adjunctive lamotrigine
2nd line management of acute depression (in preference order)
Trial several 1st line agents before Divalproex Adjunct SSRI or bupropion ECT Cariprazine Olanzapine PLUS fluoxetine
3rd line management of acute depression (in preference order)
Many choices almost always as adjunct tx, including atypical AP, SNRI, MAOi, IV ketamine, stimulants, light therapy, rTMS,
