Chapter 64: Bipolar Disorder Flashcards
(34 cards)
What is bipolar characterized by?
Fluctuations in mood from an extremely sad and hopeless state to an abnormally elevated, overexited or irritable mood
What is the definition of Bipolar I?
At least one episode of mania, and usually, bouts of intense depression.
What is mania associated with?
At least one of the following: significant impairment in social/work functioning, psychosis/delusions, or requires hospitalization.
What is the definition of Bipolar II?
At least one episode of hypomania (lasting > 4 consecutive days) and at least one depressive episode (lasting > 2 weeks).
What is the primary goal of treatment for bipolar disorder?
To stabilize the mood without inducing a depressive or manic state
What are traditional mood stabilizers?
Lithium and anti-epileptic drugs (Valproate, Lamotrigine, carbamazepine)
What states do traditional mood stabilizers treat?
Both depression and mania
Treatment choice if mania + psychosis
Antipsychotics
Acute treatment for a manic episode
- Antipsychotics (Olanzapine or risperidone)
- Lithium or Valproate
- their combo is preferred
Acute treatment for a depressive episode
- Antipsychotics (Quetiapine or Lurasidone)
- Lithium or Valproate or Limotrigine
What are the preferred maintenance monotherapies for bipolar disorder?
Lithium and antiepileptic drugs (valproate)
What are MedGuides required with?
MedGuides are required with all antidepressants and with all antipsychotics.
Why are MedGuides required with antidepressants?
Primarily due to suicide risk.
Why are MedGuides required with antipsychotics?
Primarily due to increased risk of death in elderly patients with dementia-related psychosis.
What risks are associated with valproate exposure in pregnancy?
Valproate exposure can increase the risk of fetal anomalies, including neural tube defects, fetal valproate syndrome, and long-term adverse cognitive effects.
What syndrome can carbamazepine exposure in pregnancy cause?
Carbamazepine exposure can cause fetal carbamazepine syndrome, which can result in facial abnormalities.
What abnormalities can lithium exposure in pregnancy cause?
Lithium exposure can cause an increase in congenital cardiac malformations.
What is a safer mood stabilizer option during pregnancy?
Lamotrigine is a safer option relative to other mood stabilizers.
Which mood stabilizer has the most favorable safety profile in pregnancy?
Lurasidone has the most favorable safety profile in pregnancy, but its use is limited since it is only approved for bipolar depression.
What anticonvulsants are used for the treatment of bipolar disorder?
Lamotrigine, Valproate, and Carbamazepine.
Lithium brand name
Lithobid
What is the therapeutic range of lithium?
0.6-1.2 mEq/L (trough level)
What are the warnings of Lithium?
serotonin syndrome, renal impairment, hyponatremia and dehydration
What are the side effects of Lithium when within therapeutic range?
GI upset, cognitive effects, cogwheel rigidity, tremor, thirst, polyuria/polydipsia, weight gain, hypothyroidism
