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Mental Health > Bipolar disorder > Flashcards

Bipolar disorder Flashcards

1
Q

What are the 2 types of bipolar disorder?

A

Type I = mania and depression

Type II = hypomania and depression

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2
Q

What are the symptoms of mania?

A

Mnemonic DIG FAST:
Distractibility
Irresponsibility
Grandiosity

Flight of ideas
Activity increase
Sleep deficit
Talkativeness

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3
Q

What is the difference between mania and hypomania?

A

Hypomania:
decreased or increased function for 4 days or more

Mania:
severe functional impairment or psychotic symptoms for 7 days or more

Key difference is the psychotic symptoms

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4
Q

What is cyclothymia?

A

Numerous periods of symptoms of depression and hypomania, but not sufficient to be classed as MDE or hypomanic
Symptoms must last more than 1 year in children and 2 years in adults

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5
Q

What is rapid cycling bipolar?

A

4 or more episodes of depression or mania in a year

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6
Q

What are the mood stabiliser drugs used in bipolar disorder?

A

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

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7
Q

How is acute mania managed in bipolar disorder?

A

Start antipsychotic (olanzapine, risperidone, quetiapine)

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8
Q

How is depression managed in bipolar disorder?

A

Psychological intervention

Fluoxetine is SSRI of choice

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9
Q

What baseline investigations need to be taken prior to starting lithium?

A 
FBC
U&Es
TFTs
Weight
BMI
ECG
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10
Q

What cardiac malformation can occur if lithium is used during 1st trimester and what is its occurrence rate?

A

Ebstein anomaly - 1 in 2000

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11
Q

How is lithium monitored?

A

Sample taken 12 hours post dose
After starting, levels checked weekly until concentrations are stable
Once stable lithium blood levels established, should normally check levels every 3 months

After changing lithium dose, levels should be taken a week later then weekly until levels are stable

Check thyroid and renal functions every 6 months

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12
Q

What is the therapeutic range for lithium?

A

0.4 - 1.0mmol/L

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13
Q

What side effects are associated with lithium?

A

GI distress (nausea, vomiting, appetite, diarrhoea) - most common
Fine tremor
Nephrotoxicity - polyuria due to nephrogenic diabetes insipidus
Thyroid enlargement leading to hypothyroidism
ECG changes - T wave flattening/inversion
Weight gain
Idiopathic intracranial hypertension
Leucocytosis
Hyperparathyroidism leading to hypercalcaemia

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14
Q

What symptoms occur during lithium toxicity?

A

Mild (1.5-2mmol/L)

Moderate (2-2.5mmol/L)

Severe (>2.5mmol/L)

Symptoms:
Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma
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15
Q

What can precipitate lithium toxicity and should therefore be avoided?

A 
Drugs:
NSAIDs
ACE inhibitors/ ARBs
Diuretics (especially thiazides)
Metronidazole

Conditions:
Dehydration
Renal failure

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16
Q

What baseline investigations need to be performed prior to starting carbamazepine?

A

FBC
LFTs
ECG

17
Q

What side effects are associated with carbamazepine?

A

Rash (most common) - Steven-Johnson syndrome
GI - nausea, vomiting, diarrhoea, transaminitis
Neuro - sedation, dizziness, ataxia, headache, diplopia
Leucopenia and agranulocytosis
Hyponatraemia due to SIADH secretion

18
Q

What drugs can increase carbamazepine levels?

A 
Acetazolamide
Cimetidine
Clozapine
Fluvoxamine
Fluoxetine (sometimes)
Diltiazem
Verapamil
Clarithromycin
Fluconazole
Metronidazole
19
Q

What drugs decrease carbamazepine levels?

A

Antipsychotics (Except clozapine)
TCAs
Barbiturates
Phenytoin

20
Q

What drugs can carbamazepine increase metabolism?

A 
Itself!
Oestrogen and progesterone
Antidepressants
Antipsychotics
Benzodiazepine 
Warfarin
Methadone
21
Q

What baseline investigation is needed before starting lamotrigine?

A

LFTs

22
Q

How is lamotrigine dose titrated?

A

Start with 25mg OD for 2 weeks, then 50mg OD for 2 weeks then increase 100mg OD

23
Q

What side effects are associated with lamotrigine?

A

Rash - Stevens-Johnson syndrome, toxic epidermal necrolysis
GI - Nausea, vomiting
Neuro - sedation, dizziness, ataxia, confusion

24
Q

What medication can increase the concentration of lamotrigine?

A

Sertraline

Valproic acid

Mental Health (12 decks)

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