IC 13 - Bipolar Disorder

Question 1

Bipolar Disorder is a _________ and ______ mood disorder.

Answer 1

lifelong, cyclical

Question 2

What kind of episode is predominantly found in bipolar?

Answer 2

Depressive episodes (80%)

Question 3

What kind of episode is common in the 1st episode of men?

Answer 3

Manic

Question 4

Name one class of medications that can induce mania in bipolar depression patients.

Answer 4

Antidepressants

Question 5

How does antidepressants induce mania in bipolar depression patients?

Answer 5

Increase norephedrine or dopamine transmission

Question 6

Name 3 medical conditions that induce mania.

Answer 6

1. CNS disorders (strokes, head injuries, multiple sclerosis)
2. Endocrine or hormonal (Cushing’s disease, hyperthyroidism (mania), hypothyroidism (depression))

Question 7

What are 5 drugs/ things that can induce mania?

Answer 7

1. Drug withdrawal states
2. Antidepressants
3. DA augmenting agents
4. Steroids
5. Thyroid preparations

Question 8

What is the key features of bipolar disorder?

Answer 8

History of mania or hypomania (Not due to other conditions)

Question 9

What is the main manic symptoms?

Answer 9

Abnormal and persistently elevated/ expansive/ irritable mood

Question 10

What is D.I.G.F.A.S.T.?

Answer 10

1. Distractibility and easily frustrated
2. Irresponsibility and erratic uninhibited behavior
3. Grandiosity (inflated self esteem)
4. Flight of ideas
5. Activity increased
6. Sleep: need is decreased
7. Talkativeness

Question 11

What is the clinical presentation of mania/bipolar?

Answer 11

Digfast symptoms (≥ 1 week with functional impairment)

Question 12

What does bipolar I disorder refer to?

Answer 12

Mania ± Depressive episode

Question 13

What are the important assessment that should be done to diagnose bipolar disorder?

Answer 13

Psychiatric history, mental state exam (suicidal/ homicidal ideations and risks)

Question 14

What are the labs and investigation that should be done for bipolar disorder?

Answer 14

HLA-B*1502, FBC, U/E/Cr, LFTs, TFTs, pregnancy test

Question 15

List 2 goals of treatments of Bipolar disorder

Answer 15

1. Reduce frequency, severity and duration of mood episodes
2. Prevent suicide

Question 16

Name 4 non-pharmacological methods that can be used for bipolar disorder.

Answer 16

1. Psychotherapy
2. Stress reduction
3. Educate on recognising s/sx early
4. Sleep hygiene

Question 17

Name 2 broad classes of drugs that can be used for bipolar disorder.

Answer 17

1. Benzodiazepines
2. Mood stabiliser e.g. lithium

Question 18

What are the medications that can be used for mania?

Answer 18

1. Antipsychotics (Olanzapine, Quetiapine, Risperidone, Haloperidol)
2. Lithium (1st line for maintenance and relapse/ suicide prevention)

Question 19

What are the medication for bipolar depression?

Answer 19

1. Lithium (1st line)
2. Quetiapine
3. Olanzapine with Fluoxetine
4. Lamotrigine

Question 20

Which population should not use valproate?

Answer 20

Women of childbearing potential

Question 21

What are the side effects of lithium?

Answer 21

1. Hypothyroidism
2. Fine to coarse tremors
3. Polyuria
4. Cardiac effects (ECG)
5. Nausea

Question 22

What are some interactions that may lead to Li+ toxicity?

Answer 22

1. Decrease sodium
2. Thiazides
3. ACEI/ ARBs
4. NSAIDs
5. Dehydration

Question 23

What are two side effects of sodium valproate?

Answer 23

1. Decrease platelet
2. Pancreatitis

Question 24

Name one DDI associated with sodium valproate.

Answer 24

Lamotrigine (Risk of SJS)

Question 25

What is one DDI of carbamazepine.

Answer 25

Clozapine with agranulocytosis

Question 26

What are the side effects of lamotrigine?

Answer 26

Sedation and weight gain (but lesser than others)

Question 27

What are the antipsychotics side effects?

Answer 27

EPSE, metabolic S.E, increase weight

Question 28

What is one feature of carbamazepine metabolism?

Answer 28

Induces its own metabolism and that of other drugs

Question 29

List three drugs that requires us to watch out for SJS/TEN.

Answer 29

Lamotrigine/ VPA/ carbamazepine

Question 30

What labs should be tested after initiation of Lithium and carbamazepine?

Answer 30

Low natremia

Question 31

When is long-term lithium required?

Answer 31

Recurrent depressive episodes

Question 32

For bipolar disorder with rapid cycling, _____ antidepressants/stimulants.

Answer 32

avoid

Question 33

What is the non-pharm treatment for severe mania in pregnancy?

Answer 33

ECT for severe

Question 34

What is the drug of choice for liver impairment in bipolar disorder?

Answer 34

Lithium

Question 35

What medications can be used for aggression/ violence?

Answer 35

Lithium or valproate, consider adding antipsychotic