Psychiatry: Mania

Question 1

What is Mania

Answer 1

Extreme Happiness

Question 2

Describe a Manic Episode

Answer 2

Abnormally elevated mood and energy

Talking fast, pressured speech

Decreased need for sleep
-not tired

Psychomotor agitation

Flight of ideas

Disinhibition

Grandiosity

Question 3

What is needed to diagnose a Manic Episode

Answer 3

DIG FAST symptoms for at least 1 week, most of the day

Question 4

What does the D in DIG FAST stand for

Answer 4

Distractibility

Question 5

What does the I in DIG FAST stand for

Answer 5

Irresponsibility

Question 6

What does the G in DIG FAST stand for

Answer 6

Grandiosity

Question 7

What does the F in DIG FAST stand for

Answer 7

Flight of Ideas

Question 8

What does the A in DIG FAST stand for

Answer 8

Agitation

Question 9

What does the S in DIG FAST stand for

Answer 9

Less Sleep

Question 10

What does the T in DIG FAST stand for

Answer 10

Talking too much, pressured speech

Question 11

Describe a Hypomanic Episode

Answer 11

Less severe than mania

lasts at least 4 days

no psychotic symptoms

Question 12

What is Bipolar Disorder

Answer 12

Manic Depression
-symptoms of mania and depression

Question 13

What Defines Bipolar I

Answer 13

Manic episode
-+/- Depression
- +/- Hypomania

Question 14

What Defines Bipolar II

Answer 14

Hypomania and Depression

-no manic episodes

Question 15

What is Cyclothymic Disorder

Answer 15

Mild symptoms of Mania and depression

Come and go for at least 2 years
-occur at least 1/2 the time
-never absent 2 consecutive months

Question 16

What are the treatment options for Bipolar Disorder

Answer 16

Mood Stabilizers

Antipsychotics

ECT

Question 17

What drugs may trigger a manic episode in Bipolar Disorder

Answer 17

Antidepressants

Question 18

What mood stabilizers are commonly used for Bipolar Disorder

Answer 18

Lithium

Valproic Acid

Lamotrigine

Carbamazepine

Question 19

What antipsychotics are commonly used in Bipolar Disorder

Answer 19

Aripiprazole

Haloperidol

Olanzapine

Quetiapine

Risperidone

Question 20

How do you treat new-onset acute mania

Answer 20

Lithium + Antipsychotic

alternative is Valproic Acid + Antipsychotic

Question 21

What is the therapeutic Range of Lithium

Answer 21

0.8 to 1.2 mEq/L

Question 22

How is Lithium Eliminated

Answer 22

Renal excretion

Question 23

Where is Lithium Reabsorbed

Answer 23

Proximal Tubule (like Na)

Question 24

What condition is Lithium Contraindicated with

Answer 24

Significant Renal impairment

Question 25

What condition predisposes to Lithium Toxicity

Answer 25

Acute Renal Failure

Question 26

What are common adverse effects of Lithium

Answer 26

Tremor Nausea Diarrhea Toxicity/Poisoinng Chronic effects

Question 27

What are the GI components of Lithium Poisoning

Answer 27

Nausea Vomit Diarrhea

Question 28

What are the Neurologic symptoms of Lithium Poisoning

Answer 28

Confusion Tremor Seizures

Question 29

How do you treat Lithium Poisoning

Answer 29

Stop Drug +/- Dialysis

Question 30

What are the indications for Dialysis in Lithium Poisoning

Answer 30

Level >5.0 Level >2.5 with symptoms

Question 31

When does a Lithium Tremor occur

Answer 31

When drug is started or dose is increased

Question 32

Describe the Lithium Tremor

Answer 32

Symmetric usually limited to hands or arms

Question 33

How do you treat a persistent lithium toxicity

Answer 33

Propranolol

Question 34

What is the most common adverse effect of Lithium

Answer 34

Lithium Tremor

Question 35

What are the risk factors for Lithium Toxicity

Answer 35

Renal Insufficiency -volume depletion -elderly (low GFR) Drug interactions

Question 36

What drugs Increase Lithium Level

Answer 36

Thiazides NSAIDS ACE-I Metronidazole Tetracycline

Question 37

How do those drugs increase the lithium level

Answer 37

they decrease the renal excretion

Question 38

What drug is associated with decreased lithium levels

Answer 38

Potassium-sparring diuretics

Question 39

What drug is known to have varying effects on the Lithium Level

Answer 39

Loop Diuretics

Question 40

How does Lithium Effect the Thyroid Gland

Answer 40

Inhibits Hormone release: Hypothyroidism Causes Goiter

Question 41

How does Lithium effect the Parathyroid glands

Answer 41

May elevate PTH and cause Hypercalcemia

Question 42

How does Lithium Cause DI

Answer 42

Tubules do not respond to ADH - dilute urine: low Uosm

Question 43

How do you treat Lithium Induced DI

Answer 43

Discontinue Lithium Amiloride

Question 44

How does Amiloride treat Lithium Induced DI

Answer 44

Potassium-sparring diuretic that blocks Lithium entry into renal cells

Question 45

How does Vasopressin impact Lithium Induced DI

Answer 45

It does not -there is no response This is Nephrogenic DI

Question 46

Cardiac Effects of Lithium

Answer 46

Suppresses Sinus Node -Bradycardia -Pauses -Syncope

Question 47

What is the most common birth defect in mothers using Lithium

Answer 47

Ebstein's Anomaly

Question 48

What do you need to get before starting Lithium

Answer 48

EKG Bun, Cr, Cr TSH Pregnancy test Ua

Question 49

When do you get blood levels for a patient on Lithium

Answer 49

Day 5: then q2-3 days until therapeutic Once Therapeutic q6-12 months

Question 50

When do you check Cr and TSH in a patient on Lithium

Answer 50

q3-6 months