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60 terms

Bipolar

sample Questions for MCV SOP Psych exam
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What is the Lifetime prevalence of bipolar I
1% (manic or mixed episode)
incidence of bipolar II
half of bipolar 1 0.5% (hypomanic with more depressive episodes)
What is the Ratio Of males to Females with Bipolar I
Males = females for bipolar I
What is the Ratio Of males to Females with Bipolar II
Females > males for bipolar- has alot more depressive episodes
What percent of relatives have a biologic relative with a mood disorder
80-90%
What is the Monoamine hypothesis
theres too much floating around ;excess of catecholamines (NE, DA)
Valproic acid is better for treating what type of mania
Mixed Mania
Lithium is better at treating what type of mania
Euphoric Mania
when a patient is in a hospital Why do they add a BNZ in a hospital on top of Lithium and Depakote
so the patient will sleep b/c the lithium takes so long to work
How does GABA and glutamate come into play
GABA - inhibitory
Glutamate- excitory
just know where drug therapy is going
why do we believe that Ca channels are involved
b/c when we give lithium it stabilizes membrane and it works
why do we believe that kindling has something to do with the manic state
kindling in temporal lobe, multiple stressors sensitize a specific area. what types of drugs work anticonvulsants (carbamazapine)
what is one of the big causes that shows up in a CT Scan
Tumor
What autoimmune disorder can cause people to become bipolar
HIV positive- Become manic
Medications to look at
(alcohol)
ETOH withdrawal
Medications to look at
Anti depressant
unmask Mania
you can precipitate manic episode by giving AD -throws them into mania
Medications to look at
Person on Cocaine
presents as manic
Medications to look atSteroids
this lady had gotten cancer cocktail to prevent infection and it contained dexamethasone - she went wild. they treated with depakote- kirkwood lobbied against antipsych - b.c she didn't have mood disorder
Medications to look at
(herbals)
St Johns Wort
environmental conditions
bright light and sleep deprivation
if they lose sleep for a couple days can trigger
watch sleep watch what you eat dont drink
Starting Dose of Lithium
300mg TID
What is lithiums t1/2
24hrs (1 day ) so it takes 4-5 days to Steady state - if patient is outpatient she brings them back in a week and if they are inpatient she brings back in 4-5 days
Lithium has narrow range
0.8‐1.2 mEq/L acute
we push upper limit
people with mania have high elimination
Lithium andThiazides
Thiazides are the worst. they increase more than loops. we still use together but we have to watch lithium level
what NSAID is ok?
NSAIDs and COX with exception of sulindac it is her go to
dont use ACEi with Lithium
Acei increase Lithium
Low Sodium Diet
Increases lithium
if body senses low sodium it will increase lithium absorption
Lithium Side Effects
tremorNausea, diarrhea, sedation,
fatigue, ataxia, blurred vision, rash, SIADH,
Fine hand Tremor
if lithium gets toxic it beccomes course hand tremor, fatigue ataxia, acne, leukocytosis( and increase in WBC) - this is not a problem and they use it in cancer
it doesn't mean they have and infection
Lithium and Thyroid
Reduce thyroid Hormone
1) Nephrogenic Diabetes insipidus - patient going to bathroom all day long produce dilute urine - the treatment is to give a diuretic like ameloride
what labs do we need
sodium and potassium status
Scr
TSH levels
Urinalysis - look at specific Gravity
Lithium and Pregnancy
avoid lithium during first trimester
heart abnormality (epsteins abnormality (tricuspid Valve)
Fecamila - no limbs
Labs
Why Scr
if Scr is going up then you have to reduce dose of lithium based on levels
Labs Why Urinanalysis
Look at specific Gravity ( Nephro Diabetes insipidus
Depakote Dosing
have to hit hard since they dont have much time in hospital 20mg/kg (dont do baby dosing)
target blood levels of Depakote
shoot for 80-100 ng/ml
Depakote Lamotrigine interaction
increase lamotrigine levels ( increases t1/2 of lamotrigine
Depakote and Pregnancy
always check for pregnancy
the neural tube defects
Depakote and Labs
always look at LFTs and Platlets
it decreases them (thrombocytopenia)
and LFT-Hepatotoxicity - not as concerned until its 3-5 times
Carbamazapine indication
acute mania (equitro)
Carbamazapine dosing
200 mg PO BID
Carbamazapine - unique to
induces its own metabolism (levels may go down at end of month and you may have to increase dose
Carbamazapine
Cyp inhibitor of 1A2 and Cyp3A4
so it is not first line (interacts Atypicals especially Aripiprazole)
Carbamazapine AE
Rash
Depakote indication
only for Acute Mania- it does not have maintainence
Labs to monitor with Carbamazapine
Pregancy ( NTD) same as depakote
Monitor CBC with differential )(aplastic Anemia) - they couldn't control and she was always manic and she
LFT -
What if a manic Patient being treated acutely with lithium slides into a depressive episode
if they are on lithium - just increase dose - lithium is protective
What if a manic Patient being treated acutely with depakote slides into a depressive episode
depakote does not treat depression - so you add either lamotrigine (major drug interaction)
Or Quetiapine or even lithium
What is another mono therapy option for bipolar depression
Quetiapine- but it can also be used alone b/c it is a mood stabilizer
In what situation could you be forced to use depakote and lamictal
Lets say you have a morbidly obese person being acutely treated with depakote and doctor wants to avoid quetiapine to avoid weight gain
Dosing for depressive episodes of lamotrigine
if you add lamictal it gets complicated
lamictal alone goal dose is 200 mg (by week 6
lamictal with depakote goal is 100 mg by week 6)
What if a manic Patient being treated acutely with Carbamazepine slides into a depressive episode
Carbamazapine- is an inducer- if you add lamictal goal dose is 400 b/c Carb is chewing it up
Why do we titrate lamictal so slow
we are trying to avoid Steven Johnson Syndrome if you dose too quickly it could produce a rash that can progress to SJS
What is the starting dose of Lamictal
25 mg day lamictal to start
whats the problem for using AD to treat the Bipolar disorder
Might increase Rapid Cycling
When is Bupropion CId
Do not use Bupropion ever in someone who has a eating disorder or seizure disorder
whats should be obtained from 25 year old female
pregnancy test
Na
LFT
Chem 7
CBC
TSH
Tumor
Drug Screen
- neg pregnancy
- Labs look Fine
What drug Therapy
Lithium
what % of bipolar patients attempt suicide
50%
what is the • DSM-Iv Criteria for Mania
>1 week of abnormal and persistent irritable mood with 3+:

Inflated self-esteem, increased talk, racing thoughts, distractible, increased activity
What is Cyclomania
hypomania + subsyndromal depression.