Bipolar Disorder

Question 1

Bipolar disorder is depression mixed with episodes of ___

Answer 1

Mania

Question 2

Symptoms of a manic episode include

Answer 2

Increased irritability and increased energy for at least 1 week (or any time if hospitalized) as well as a decreased need for sleep

Question 3

True or False: mental status exams are unable to differentiate between unipolar and bipolar depression

Answer 3

True. Family history and being < 25 years old is needed to be able to diagnose bipolar depression

Question 4

True or False: suicide rate in bipolar depression is half of that in unipolar depression

Answer 4

False. It is double

Question 5

True or False: the severity of a manic episode in Bipolar 1 disorder is greater than in a patient with Bipolar 2 disorder

Answer 5

True

Question 6

True or False: patients with bipolar depression spend less time in a depressed state than in a manic state

Answer 6

False. More time is spent in a depressed state

Question 7

5HT and DA have a(n) ___ relationship

Answer 7

Direct. Agonism of serotonin receptors inhibits dopamine release. The inhibition of serotonin receptors increases dopamine release

Question 8

An excess of dopamine can lead to ___

Answer 8

Mania

Question 9

A deficit of dopamine can lead to ___

Answer 9

Depression

Question 10

There is a 30% prevalence of depression in ___ disease due to deficits of dopamine

Answer 10

Parkinson’s

Question 11

Bipolar disorder is associated with ___ activity in the amygdala, ___ activity in the hippocampus, and ___ activity in the prefrontal cortex

Answer 11

Increased
Decreased
Decreased

Question 12

These 3 medications are used to treat acute and chronic depression + acute and chronic mania

Answer 12

Lithium
Quetiapine
Olanzapine

Question 13

These 5 medications are used to treat only acute and chronic mania

Answer 13

Risperidone
Aripiprazole
Ziprasidone
Divalproex (valproic acid)
Carbamazepine

Question 14

This medication only treats acute depression

Answer 14

Lurasidone

Question 15

This medication only treats chronic depression

Answer 15

Lamotrigine

Question 16

This medication is the “most typical atypical”

Answer 16

Risperidone

Question 17

What is the dosing and target level of Lithium?

Answer 17

Dosing: 600-900mg/day

Target level: 0.6-1.2mEq/L (1.2-1.5mEq/L in severe mania)

Question 18

These medications increase lithium concentrations

Answer 18

Thiazides

Question 19

These medications decrease lithium concentrations

Answer 19

Caffeine

Question 20

Adverse effects of lithium

Answer 20

Polyuria, increased thirst, renal impairment, hypercalcemia, hypothyroidism, fine motor tremor

Question 21

This adverse effect of lithium may occur during the first 6 months or may even take years to develop

Answer 21

Hypothyroidism

Question 22

At steady state, a supplemental 300mg dose of lithium will increase lithium concentration by ___ mEq/L

Answer 22

0.2

Question 23

This antipsychotic is associated with teratogenic effects and an increase in GABA

Answer 23

Valproic acid

Question 24

What are common adverse effects of valproic acid

Answer 24

Homer Simpson - Alopecia, weight gain, hepatic impairment

Question 25

Valproic acid dosing

Answer 25

Initial: 500-1000mg in 1 to 2 divided doses | Max of 60mg/kg

Question 26

Most formulations of valproic acid are given BID except for:

Answer 26

Divalproex ER. It is dosed QD and is only 80% bioavailable. It requires a 20% dose increased when switching from other formulations

Question 27

Which medication, used for bipolar disorder, is an "auto-inducer" for CYP3A4

Answer 27

Carbamazepine. It will reduce its own drug concentration over time

Question 28

What is the dose and target drug level for carbamazepine?

Answer 28

200-600mg/day in divided doses | 4-12mcg/mL

Question 29

What is a common side effect for carbamazepine?

Answer 29

Rash

Question 30

What two medications are used off-label for the treatment of bipolar disorder?

Answer 30

Oxcarbazepine and topiramate

Question 31

What medication is used for "maintenance" treatment of bipolar disorder

Answer 31

Lamotrigine

Question 32

What is the initial dose of lamotrigine? Changes are made to that dose in the presence of what other medications?

Answer 32

25mg QD If taking VPA - 25mg QoD If taking carbamazepine or phenytoin - 25mg BID

Question 33

A rare but serious side effect of lamotrigine is ___

Answer 33

Stevens-Johnson Syndrome

Question 34

___ is the active metabolite of risperidone

Answer 34

Paliperidone

Question 35

What are common side effects of quetiapine?

Answer 35

Sedation and weight gain

Question 36

This medication, used for acute mania or mixed episodes, should be taken with a meal > 500 calories

Answer 36

Ziprasidone. This is done to increase absorption

Question 37

What medication, used for bipolar depression, should be administered with a meal > 350 calories and needs to be dose adjusted in hepatic impairment

Answer 37

Lurasidone

Question 38

Capiprazine takes ___ to see an effect (whether good or bad) from a dose change

Answer 38

Several weeks

Question 39

___ decrease the concentration of lamotrigine

Answer 39

Hormones (oral contraceptives)

Question 40

A common side effect of lurasidone is ___

Answer 40

Akathisia (restlessness)