bipolar

Mania is abnormally elevated or irritable mood for at least a ______.

week

Diagnosis of bipolar **

• Exhibits ≥3 symptoms or

• If mood is only irritable, exhibits ≥4 symptoms

SXS: inflated self esteem, needs less sleep, more talkative than normal, jumping from topic to topic, easily distracted, inc in goal directed activity, high risk pleasurable activities

Mood stabilizers (4)

• Lithium

• VPA

• Lamotrigine

• Carbamazepine

Antipsychotics can stabilize the mood when mania occurs with _____

psychosis

T/F: Antidepressants always need to be used in combination with a mood stabilizer

TRUE - bc antidepressants can induce or exacerbate a manic episode when used as monotherapy

MANIC EPISODE TX OPTIONS (3)

• Antipsychotic (olanzapine)

• Lithium

• VPA

DEPRESSIVE EPISODE TX OPTIONS (4)

• Antipsychotic (quetiapine)

• Lithium

• VPA

• Lamotrigine

Lithium therapeutic range: ___-___ mEq/L (trough)

0.6-1.2 mEq/L

Lithium BW

Monitor lithium levels

Lithium adverse effects (8)

• GI upset

• Cognitive effects

• Cogwheel rigidity

• Tremor

• Thirst

• Polyuria/polydipsia

• Weight gain

• Hypothyroidism

What effects will you see with lithium toxicity?

• >1.5 mEq/L: ataxia, coarse hand tremor, vomitting

• >2.5 mEq/L: CNS depression, arrhythmia, seizure, coma

What labs should you monitor with lithium? (3)

Lithium levels, renal, thyroid

Can you use lithium in pregnancy?

NO - avoid

Lithium DDI

• SSRI, SNRI, triptans, linzeolid, etc: increase risk of serotonin syndrome

• Salt can decrease lithium levels

• ACE/ARB due to sodium loss can increase lithium levels

• NSAIDs can increase lithium levels

Lithium conversion ***** KNOW study gal

5 mL citrate syrup = 300 mg carbonate = 8 mEq ion

Mood stabilizer of choice in pregnancy

Lamotrigine

T/F: Maintain consistent salt intake with lithium

True