Bipolar Disorders Lecture Notes v1

Flashcards created from lecture notes on bipolar disorders, covering symptoms, treatment options, and key considerations in diagnosis.

Symptoms of bipolar mania

Increased energy,

reduced need for sleep

racing thoughts,

elevated mood,

impulsivity, and risky behavior.

Bipolar 1 vs Bipolar 2 disorders

Bipolar 1 includes episodes of mania;

Bipolar 2 features episodes of major depression and milder hypomania.

Symptoms of bipolar mania

Increased energy,

reduced need for sleep

racing thoughts,

elevated mood,

impulsivity, and risky behavior.

Bipolar 1 vs Bipolar 2 disorders

Bipolar 1 includes episodes of mania;

Bipolar 2 features episodes of major depression and milder hypomania.

Misdiagnosis of Bipolar 2 as Major Depression

Bipolar 2 may be misdiagnosed due to depressive episodes dominating and not recognizing hypomanic episodes.

Impact of MDD diagnosis instead of BP2

MDD treatments can exacerbate bipolar symptoms leading to worsening mood instability.

True or False: There are more women than men with bipolar disorders.

F

Average age of onset for bipolar disorders

late adolescence to early adulthood.

Danger of misdiagnosing ADHD as bipolar disorder

lead to inappropriate treatments and management strategies since symptoms may overlap.

Sxs of bipolar depression vs major depression

share similar symptoms (e.g., D/A+SIGECAPS) but differ in treatment approaches.

Recommendation for a patient on Prozac with manic symptoms

Consider reevaluation of antidepressant use and potentially switch to a mood stabilizer.

Baseline labs for lithium therapy

Renal function tests (e.g., serum creatinine), electrolytes, and thyroid function tests.

Therapeutic lithium level range

Usually between 0.6 to 1.2 mEq/L.

Timing for lithium level labs post-dose

Typically 12 hours after the last dose to ensure accurate measurement of drug levels.

Common DDIs causing lithium toxicity

NSAIDs, diuretics, and certain ACE inhibitors.

Symptoms of lithium toxicity

Nausea, vomiting, diarrhea, tremors, confusion, and seizures.

Recommended interventions for lithium toxicity

Hydration and possibly facilitating elimination of lithium.

Medications for acute mania prior to lithium

Atypical antipsychotics, benzodiazepines.

FDA-approved atypical antipsychotics for bipolar depression

Quetiapine (Seroquel), Lurasidone (Latuda), Olanzapine-Fluoxetine combination.

Indications and ADRs for Caplyta®

Approved for schizophrenia and bipolar depression; Common ADRs include somnolence and akathisia.

CrCl < ___ ml/min and lithium therapy

Patients with a creatinine clearance less than 30 ml/min should not be on lithium.

Effects of a 2-gm sodium restriction diet on lithium

Can increase lithium retention, leading to higher blood levels.

Anticonvulsants for bipolar disorder treatment

Valproate (Depakote), Carbamazepine (CBZ), Lamotrigine (Lamictal).

Advantage of Depakote® vs Depakene®

Depakote® has fewer gastrointestinal side effects and better tolerated; Antacids can reduce absorption of Depakote®.

Risks of using CBZ or VPA during pregnancy

Increased risk of teratogenic effects and developmental issues.

Patient education for carbamazepine with oral contraceptives

CBZ can reduce effectiveness of hormonal contraceptives.

Effectiveness of lamotrigine for acute mania

Lamotrigine is not effective for acute mania; it's used for maintenance.

Patient education point for starting lamotrigine

Importance of gradual titration to reduce the risk of serious skin rashes.

Dosing precaution for lamotrigine with VPA

Lower starting dose is required for patients receiving valproic acid to avoid toxicity.

Best mood stabilizer for pregnant patients with Bipolar 2

Lamotrigine is often considered safer during pregnancy.

FDA-approved antipsychotics for bipolar mania and depression

Olanzapine (Zyprexa), Quetiapine (Seroquel), Lurasidone (Latuda).

Neuroprotective mood stabilizer under study

Lithium is being studied for neuroprotective properties in Parkinson's and Alzheimer's disease.