Define bipolar I
at least one episode of mania, and usually, bouts of intense depression (a depressive episode is not required for diagnosis)
For bipolar I disorder, mania must be associated with at least one of the following:
significant impairment in social/work functioning, psychosis/delusions or requires hospitalization
Define bipolar II
at least one episode of hypomania (lasting ≥ 4 consecutive days) and at least one depressive episode (lasting ≥ 2 weeks)
For bipolar disorder II, hypomania
does not affect social/work functioning, does not cause psychosis nor requires hospitalization
Define bipolar depression
predominant symptoms of a depressive episode include feelings of sadness or depressed mood and/or loss of interest
Define psychosis
severe mental condition where there is a loss of contact with reality, involves abnormal thinking and perception (ex: hallucinations and delusions)
Define bipolar disorder
characterized by fluctuations in mood from an extremely sad or hopeless state to an abnormally elevated, overexcited or irritable mood called mania or hypomania
Define mania
abnormally elevated irritable mood for at least a week (or any duration if hospitalization is needed)
Diagnosis of mania
exhibits ≥ 3 symptoms (if mood is only irritable, exhibits ≥ 4 symptoms)
Symptoms of mania
inflated self-esteem, needs less sleep, more talkative than normal, jumping from topic to topic, easily distracted, increase in goal-directed activity, high-risk pleasurable activities (buying sprees, gambling)
What is the goal of treatment for bipolar disorder
stabilize the mood without inducing a depressive or manic state
Which mood stabilizers treat both mania and depression, without inducing either state
lithium and antiepileptic drugs (valproate, lamotrigine and carbamazepine)
Acute first-line treatment for manic episode
antipsychotic (olanzapine, risperidone), lithium and valproate
(combination of an antipsychotic + lithium or valproate is preferred for severe episodes)
Acute first-line treatment for depressive episode
antipsychotic (quetiapine, lurasidone)
(lithium, valproate or lamotrigine can be added or used as alternatives)
MedGuides are required with all
antidepressants and antipsychotics
Which antiepileptic drug requires a slow titration due to the risk of a severe rash
lamotrigine
Brand name for lamotrigine
Lamictal
Brand name for valproate/valproic acid derivatives
Depakote
Brand name for carbamazepine
Equetro
Major concern with antipsychotics is the risk of
EPS
What generation of antipsychotics have a higher risk of EPS
first-generation
Brand name of aripiprazole
Abilify
Brand name of olanzapine
Zyprexa
Brand name of quetiapine
Seroquel
Brand name of risperidone
Risperdal
Brand name of ziprasidone
Geodon
Brand name lurasidone
Latuda
MOA of lithium
influencing the reuptake of serotonin and/or NE or by moderating glutamate levels in the brain
(glutamate is the primary excitatory neurotransmitters, so high levels can cause mania)
Brand name for lithium
Lithobid
Therapeutic range of lithium
0.6 - 1.2 mEq/L (trough level)
Signs/symptoms of lithium level >1.5 mEq/L
ataxia, coarse hand tremor, vomiting, persistent diarrhea, confusion, sedation
Signs/symptoms of lithium level >2.5 mEq/L
CNS depression, arrhythmia, seizure, coma
Lithium levels increase with
decreased salt intake, sodium loss (ACEi, ARBs, thiazide diuretics), NSAIDs
Lithium levels decrease with
increased salt intake, caffeine and theophylline
5 mL lithium citrate syrup =
8 mEq of lithium ion
8 mEq of lithium ion =
300 mg lithium carbonate tabs/caps
increased risk of neurotoxicity if lithium is taken with
verapamil, diltiazem, phenytoin and carbamazepine
Which antipsychotic has the most favorable safety profile in pregnancy
lurasidone