Bipolar

Question 1

Bipolar I

Answer 1

• More severe mania followed by bouts of intense depression
• May be psychotic or delusional
• May be misdiagnosed as having depression only

Question 2

Bipolar II

Answer 2

• Hypomania following bouts of major depressive disoder
• Hypomania does NOT require social/work fxning and does NOT cause psychosis
• May be misdiagnosed as having depression only

Question 3

Mania

Answer 3

-Abnormally elevated/irritable mood for at least a week

3+ sxs unless irritable mood only - 4+ sxs:

• Inflated self-esteem
• Sleeping less
• Talkative
• Jumping from one topic to another
• Easily distracted
• Increases in goal-directed activity
• High-risk, pleasurable activities (shopping, sex, gambling)

Question 4

Illicit Drugs Causing Mania

Answer 4

• Crack
• LSD
• Meth
• Bath salts

Question 5

Acute Mania Episode Tx

Answer 5

First Line

• Valproate
• Lithium
• PLUS: Antipsychotics (SGA can help with stabilizing mood w/o inducing depression)

Question 6

Acute Depressive Episode Tx

Answer 6

• First line: Lithium
• Alt: Lamotrigine
• *Don’t give antidepressants, can induce mania**

Question 7

Maintenance Drug Choices

Answer 7

• Lithium
• Valproate
• *ALL antidepressants (suicide risk)/AP (death risk in elderly, dementia pts) require med guides**

Question 8

Preggo + Bipolar Options

Answer 8

• Avoid valproate (fetal harm), carbamazpeine, and lithium
• First line: Lamotrigine (safer)
• Alt: Lurasidone (Latuda) is most favorable BUT only for bipolar depression

Question 9

Lithobid

Answer 9

• Lithium, BID (extended release option)
• Commonly used for mania/depression/maintenance
• Often paired with SGA in SEVERE cases
• Range: 0.6-1.2 mEq/L (trough!)
• Warning: 5HT syndrome
• LOTS of SE: GI upset, cog. effects, weight gain, cogwheel rigidity, polyuria/dypsia, anorexia, edema, impotence, etc.
• Blue/grey skin pigmentation!

Question 10

Lamictal

Answer 10

• Lamotrigine
• Rash risk (increased with valproate)
• Slowly titrate

Question 11

Sumbyax

Answer 11

• Olanzapine + Fluoxetine

- Relatively popular for bipolar, more so with depression

Question 12

Depakene

Answer 12

• Valproate (AKA Depakote)
• Increases risk of rash in lamotrigine patients
• Fetal harm!

Question 13

Equetro

Answer 13

• Carbamazepine

- HLA-B-1502* testing required

Question 14

Lithium Toxicity SE

Answer 14

> 1.5 mEq/L

• Ataxia
• Cough
• Hand Tremor
• Vomiting

> 2.5 mEq/L

• CNS depression
• Arrhythmia
• Seizure
• Coma