Term
| How many types of bipolar are there, and differentiate. |
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Definition
| Type I: disorder involves episodes of severe mood swings, from mania to depression.
Type II: is a milder form, involving milder episodes of hypomania that alternate with depression. |
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Term
| What are the symptoms of Mania? |
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Definition
| Patients love this phase: Hate to be slowed down
Easily distracted, very creative, start many projects & not finish them; jump from one subject to subject
Increased travel (hospitalization in diff hospitals)
SOCIALLY DYSFUNCTIONAL |
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Term
| What is the DSM-IV Type I Bipolar disorder diagnosis criteria? What is rapid cycling? |
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Definition
| DSM-IV Diagnosis
Presents w/Manic & Depression, can start as FULL BLOWN DEPRESSION
Medical problem: Classic Mania/Depression
Rapid cycling: is characterized by four or more mood episodes that occur within a 12-month period. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness. Women are more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts.
Know Depression |
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Term
| DSM-IV Bipolar Tips for Type I Bipolar Disorder. |
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Definition
Bipolar I Disorder--Diagnostic Features (DSM-IV, p. 350)
The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. . . |
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Term
| How to describe Episodes of bipolar disorder? |
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Definition
| Mania:Feeling good, spending money, travel, & hypersexuality
Depression Hypomania: not complete mania, socially functional Rapid Cycler: 4 or more cycles (1 peak + 1 trough) in 1 year |
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Term
| Exam II hints for Bipolar Case: |
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Definition
| Most likely patient will already be diagnosed and will present to you with an axascerbation per drug interaction or life triggers. |
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Term
| Possible Bipolar Exam Scenarios: |
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Definition
| 1. Pt comes in MANIC w/ AGGRESSION, always offer PO version FIRST, then IM.
2. If scute IM med works --> switch to PO form when possible, w/ or w/o Lithium, Valproic in combination
3. If patient is suicidal & need to start Antidepressant- get diagnostic workup, ***DON'T USE VALPROIC ACID***
4. If using Haldol & Ativan for acute agitation; don't stop there, MAINTENANCE DOSE NEEDED
5. If pat >/= 300lb. (IBW is 180) don't use antipsychotic (AP) except ABILIFY
6. Geodon causes QTc prolongation if they have high K+ levels |
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Term
| Bipolar disorder treatment tips: |
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Definition
| 1. Always start w/ MOOD stabilizer (manic or depressive).
2. Manic: 2 agents, MOOD stabilizer and 2nd generation AP.
3. Depression: start w/ MOOD stabilizer (Lamotragine, Lithium alone, or in combo, Quetiapine alone or in combo, Abilify alone or in combo). If severe depression, can start w/ just 1. If If this doesn't work --> use antidepressant. |
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Term
| What are the behaviors of a hypomania bipolar patient? |
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Definition
| 1. They set many goals and need 5-6 hours of sleep.
2. Employers love this type of patient.
3. Hypomania doesn't mean docially dysfunctional, they are very productive. |
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Term
| What affects Lithium carbonate/citrate blood levels and some pharmacological characteristics? |
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Definition
| 1. Low sodium = increased bllod [Lithium]
2. Lithium 100% renally eliminated; MUST CALCULATE CrCl in monitoring section
3. Lithium C/I in DM patients, bc GFR goes down and [increased Lithium]
4. ACE inhibitors, fluoxetine, loop diuretics, NSAIDs, thiazide diuretics
Increased lithium serum levels.
5. Carbamazepine, haloperidol, methyldopa
Increased neurotoxic effects despite therapeutic serum levels and normal dosage range.
6. Pregnancy Category D . |
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Term
When do you use Lithium in bipolar patients?
What is the connection with lithium and hypothyroidism? |
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Definition
| *You use Lithium in ACUTE MANIA, MAINTENANCE
Lithium decreases thyroid hormone level (look for increased TSH).
Monitor thyroid levels annually for stabilized patients and 1,3,6, then 12 months.
Watch for SrCr, caution if >1.0 |
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Term
| What is the connection of Lithium and an EKG? |
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Definition
| Lithium patients need to have a baseline EKG,patients on Li can look like they have MI (flat or inverted T-wave; normal for Lithium patients) |
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Term
| Caffiene and Lithium blood levels, what does it do? |
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Definition
| Caffiene decreases Lithium blood levels. |
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Term
| If a bipolar patient needs pain medication, i.e. ibuprofen, what do you do? |
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Definition
| 1. D/C ibuprofen
2. give Sulindac (150mg BID, don't exceed 400mg); counsel==>NSAID (no EtOH, take with food and water(N/V), take the same time everyday)
Monitor for serious SE: •Chest pain
•Shortness of breath
•Weakness on one part of your body
•Slurred speech.
OKAY to take with APAP |
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Term
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Definition
| Stay hydrated, but don't drink more than >64oz. of water/day to prevent diluting blood levels. |
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Term
| How long does it take for Lithium to work? |
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Definition
| 1. It takes 7-10 days to break manic depression back to Euthymic state or to start downward trend to euthymic
2. Drinking caffienated beverages ==> decreased Lithium levels |
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Term
| How is valproic acid used in Bipolar Disorder? |
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Definition
| NOT A MONOTHERAPY
Use adjunctively with AAP for mixed mania
Tx: Mania & Mixed
Dose: 10-20mg/kg/day in divided dosees
SE:N/V/D, Alopecia, tremors
Maintenance Dosing: Target 80-120 mg, Therapeutic range: 50-120mg if at 80-85 mg and no affect, reconsider other therapies
Monitoring: CBC w/ diff & LFT, blood level |
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Term
| Bipolar: Depression; how do you treat and why? |
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Definition
| Bipolar depression; Tx with moodstabilizer (Lamotragine, Lithium alone or in combo, Abilify alone or combo)
if not severe depression start w/ 1 agent, IF DOESN'T Work --> use antidepressant |
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Term
| What is the treatment for Acute mania/Mixed Episodes in bipolar disorder? |
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Definition
Lithium, valproate, and AP medications
ECT if non responsive to all therapy |
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Term
| What is the 1st line Tx to stabilize mood? |
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Definition
| Lithium
valproate
Divalproex
Carbemezepine
2nd line: AAP
*if 300lbs (IBW 180) don't use AP ecept ABILIFY |
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