bipolar

bipolar

hypomania - doesn’t affect social/work fxn, doesn’t cause psychosis, no hospitalization

mania - at least one: impairment of social/work fxn, psychosis/delusion, hospitalization

psychosis - loss of contact w reality

bipolar I - at least 1 ep mania

bipolar II - at least 1 ep hypomania (last 4+ d) and at least 1 depressive ep (last 2+ wks)

bipolar diagnosis

3+ (4+ if mood only irritable) x1 wk or hospitalization

• inflated self esteem

• needs less sleep

• more talkative

• jumping topics

• easily distracted

• increase in goal directed activity

• high risk pleasurable activities

bipolar treatment

don’t induce

• mania+depression: mood stabilizers (lithium) and antiepileptic (valproate, lamotrigine, carbamazepine)

• mania+psychosis: antipsychotics

• SGA>FGA d/t EPS

induce

• antidepressants (use w mood stabilizer)

acute

• manic: antipsychotic, lithium, valproate

  • severe: antipsychotic + lithium/valproate

• depressive: antipsychotic

  • add on/alt: lithium, valproate, lamotrigine

maintenance

• use meds that worked for acute

lithobid

lithium

• trough: 0.6-1.2

• warnings: SS

• s/e: GI upset, slow thinking, tremor, thirst, polyuria/polydispia, weight gain, hypothyroid

  • >1.5: ataxia, coarse tremor, vomit

  • >2.5: CNS depression, arrhythmia, seizure, coma

• renally cleared

• teratogenic

• DDI: incr w decr salt/NSAIDs

• 5 mL = 8 mEq = 300 mg