IC12 Bipolar Disorder Flashcards
(50 cards)
How does bipolar disorder usually manifest in males and females?
Manic episodes in males
Depressive episode in females
Describe bipolar disorder
lifelong cyclical mood disorder with a variable course, manifesting with recurrent fluctuations in mood, energy and behaviour
Which medications can induce mania in bipolar d/o? (8)
- Drugs of abuse (alcohol intoxication, hallucinogens)
- Drug withdrawal states (alcohol, barbituates, benzodiazepines)
- Antidepressants (MAOIs, TCAs, 5-HT and/or NE and/or DA reuptake inhibitors, 5HT antagonists)
- DA-augmenting agents (CNS stimulants like amphetamines, cocaine; sympathomimetics like DA agonists, releasers and reuptake inhibitors)
- NE-augmenting agents (α2-antagonists, β-agonsits, NE reuptake inhibitors)
- Steroids (anabolic, adrenocorticotropic hormone, corticosteroids)
- Thyroid preparations (T3 or T4 (T3 stronger))
- OTC decongestants (pseudoephedrine)
What is the key clinical feature of bipolar d/o?
History of mania or hypomania not caused by any other conditions or substances
What are the symptoms of mania? (7)
- Abnormal and persistently elevated, expansive or irritable mood (DIGFAST acronym)
- D: Distractabile and easily frustrated
- I: Irresponsible and uninhibited erratic behaviour (resentful of actions when high)
- G: Grandiosity and inflated self-esteem
- F: Flight of ideas (say things faster than we can write, too many thoughts)
- A: Activity increased (cannot sit still, psychomotor agitation)
- S: Sleep need decreased, feel well rested after only 3h, don’t feel the need to sleep (not insomnia)
- T: Talkativeness (difficulty in interpreting)
When is a patient considered to be having a manic episode in relation to the 7 DIGFAST mania symptoms?
at least 3 symptoms plus the elevated or expansive mood
What constitutes major depressive, manic and hypomanic states in terms of duration of symptoms, according to DSM-5?
major depressive if sx > 2 weeks
manic if sx ≥ 1 week (functional impairment)
hypomaniac if sx ≥ 4 days (no functional impairment)
What does Bipolar I and Bipolar II refer to?
Bipolar I refers to mania +/- depressive episodes
Bipolar II refers to hypomania + depressive episodes
Which labs are relevant to test for (general assessment) for bipolar d/o? (5)
- FBC, urea, electrolytes, creatinine, LFTs, TFTs → if liver fx not good, drugs can cause toxicity
- pregnancy test → many mood stabilisers are teratogenic like valproate and lithium
- urine toxicology → patients may lie, assess for barbituates, benzodiazepines, cocaine, ketaminoids (standard 23 items)
- exclude other general medical conditions or substance-induced or withdrawal symptoms
- test for HLA-B*1502 genotype mandated prior to starting carbamazepine
What are the 2 main treatment goals for bipolar d/o?
- Reduce frequency, severity and duration of mood episodes
- Prevent suicide
What are non-pharmacological management options for bipolar d/o? (5)
- Psychoeducation about the disorder, treatment and monitoring for the patient and the caregiver (recognise early signs and symptoms of mania and depression, keep a list of actions that they usually resort to (eg. excessive spending))
- Psychotherapy (individual, group or family) (iCBT or behavioural couples therapy
- Stress reduction techniques (relaxation therapy)
- Sleep hygiene (regular bedtime and awake schedule)
- Nutrition and exercise
What two main classes of drugs can be given for bipolar d/o and what symptoms do they help with?
- Benzodiazepines (help pt relax and sleep)
- Mood stabiliser
When should mood stabilisers be started and why?
start early as they usually take 3-5 days to work
Which 3 drugs can be given for mania in BPD?
- Antipsychotics (risperidone gd for severe mania)
- Lithium
- Valproate
(look at antipsychotics over lithium first in mania due to renal toxicity, hypothyroidism SE and DDIs)
Which 3 drugs can be given for bipolar DEPRESSION?
- Lithium (1st line for maintenance, relapse and suicide prevention)
- Antipsychotics (use quetiapine alone or combination of olanzapine + fluoxetine (olanzapine alone is not as good for MDD))
- Lamotrigene (no anti-manic properties)
When should valproate not be used?
female patients of childbearing potential < 55 years old due to risk of fetal malformation
What are the side effects of lithium? (9)
- hypothyroidism
- tremors
- polyuria
- ECG changes
- nausea
- weight gain
- fatigue
- cognitive impairment
- diabetes insipidus
What circumstances can increase lithium levels? (5)
STAND
1. sodium depletion
2. thiazide diuretics
3. ACEi/ARBs
4. NSAIDs
5. dehydration (salt-restricted diets)
What is the target serum level for valproate and how long does it take to reach steady state?
50-125 mcg/mL
3-5 days
What are the prominent side effects of valproate? (4)
- Decreased platelets
- Pancreatitis
- SJS/TEN
- Weight gain
Which prominent drug interaction should be taken note of with valproate?
Lamotrigene (risk of SJS)
What is the target serum level for carbamazepine?
4-12 mcg/mL
What is the most prominent side effect of carbamazepine?
SJS/TEN
Which prominent drug interaction should be taken note of with carbamazepine?
Clozapine (risk of agranulocytosis)
