CANMAT Guidelines: Bipolar Disorder Part 3 + general Bipolar DSM Flashcards
what are the most common comorbid conditions with BD
SUB
anxiety
personality disorder
impulse control disorder (ODD, ADHD, CD)
what is the prevalence of SUDs in BD
33%-45%
what is the only treatment for alcohol use disorder co-morbid with BD in the guidelines with level 2 evidence (theres none higher)
lithium + divalproex (compared to lithium alone)
*watchout for electrolyte imbalances and liver function issues
theres level 3 and 4 evidence for other tx like disulfiram, naltrexone, gabapentin etc
is quetiapine recommended for treatment of AUD co-morbid with BD
no–lack of efficacy shown
what % of people with BD have cannabis use disorder
20%
what affect does cannabis have on course of BD
associated with more time in affective episodes and rapid cycling (as well as a bunch of other stuff like more psychotic features)
what medication showed benefit in treating cocaine use disorder co-morbid with BD
citicoline
also lithium and/or divalproex alone or in combo
buprioprion has anecdotal evidence
which medication has the most evidence of efficacy for treating OUD comorbid with BD
methadone
but lack of research in this area and there is concern with risk of overdose so should consult CRISM guidelines
what non-BD related medication may be reasonable to consider using to treat anxiety when comorbid with BD? why this med? do we have evidence for this?
pregabalin
effective and not associated with risk of mood destabilization and is well tolerated
not tested in BD population
list medications that have evidence for treating anxiety symptoms/GAD in those with BD
quetiapine
lamotrigine or olanzapine + lithium in those who are euthymic and already on lithium
olanzapine + fluoxetine
gabapentin adjunctive therapy
does OCD have higher rates in those with BD compared to the general population
yes
*“some researchers have posited that the high rate of co-occurrence might reflect a distinct bipolar phenotype rather than separate disorders.”
what % of those with BD also have a co-morbid personality disorder
42% per a meta analysis
what was the most prevalent co-morbid personality disorder with BD
obsessive compulsive PD
then borderline, then avoidant, then paranoid, then histrionic
what medications may provide relief for those with borderline PD co-morbid with BD
divalproex and lamotrigine
what % of adults with ADHD also meet the criteria for BD
up to 20%
what % of patients with BD also meet criteria for adult ADHD
10-20%
how do you approach treatment of comorbid ADHD and BD
treat the mood symptoms first then treat ADHD
reduced risk of mania with use of methylphenidate when treated concurrently with a mood stabilizer
treatment with lithium was associated with reduced risk of what diseases
stroke and cancer
what baseline lab investigations should be done in patients with bipolar disorder
+ prolactin
+pregnancy test (if relevant)
what medical monitoring should be done for those on lithium therapy
thyroid function
renal function
plasma calcium
–assessed at 6 months then at least annually thereafter
what medical monitoring should be done for those on divalproex therapy
menstrual hx (to assess for PCOS)
hematology profile
liver function tests
–assessed at 3-6 month intervals during 1st year then at least annually thereafter
what patient education should be done for those on carbamazepine or lamotrigine therapy
routine education about risks of skin rashes or potential for stevens johnson syndrome or toxic epidermal necrolysis
patients should contact healthcare professional if develop rash or mucosal ulcers
which population should receive genetic screening before starting carbamazepine? why?
high risk populations like Han Chinese and other asian populations
make sure do not have human leukocyte antigen (HLA)-B*1502 allele–> confers high risk for SJS/TEN with carbamazepine
what medical monitoring should be done for those on carbamazepine therapy
serum sodium levels at least annually due to risk of hyponatremia
