| Question | Answer |
| Manic Episodes | -elevated, expansive, or irritable for at least 1wk
-grandiosity, decrease in need for sleep, more talkative, racing thoughts, distractibility, increased agitation, excessive risk-taking |
| Hypomanic Episodes | for at least 4 days
-same symptoms as manic epidodes
-no marked impairment/hospitalization/pscyhosis |
| Mixed State | -mix of manic and depressed
-depressed:
1 of these: depressed mood, decr. interest/pleasure
plus 4 of these: change in weight/appetitem, insomina, agitation, fatique, guilt, decr.ability to think. thougths of death |
| Drug for bipolar disorder: the mood-stabilizing agents | LVCL-Lithium, valproic acid(Depakote; Depakene), carbamazepine (Tegretol), lamotrigine (Lamictal)
-not effective alone in major depression
-effective against both manic and depressive stages of bipolar
-Teratogenic esp. 1st trimester |
| atypical neuroleptics in bipolar disorder | risperidone, ziprasidone, olanzapine, quetiapine, asenpaine, aripirazole |
| lithium | effective initially, but wears off-need a substitution or addition of Rx
-predictors of poor response: rapid cycles, family Hx, Hx of drug abuse, mixed state |
| Acute Treatment with lithium | -1-2wk latency
-neuropleptic often combined; BZD for first few weeks
-0.8-1.5mEq/L (blood level); 2+ mEq/L (toxic)
low therapeutic index drug-potential cardiotoxicity |
| chronic treatment with lithium | first agent for maintenance
-therapeutic range=0.6-1.2 mEq/L
-may need to add neuroleptic, anticonvulsant, or antidepressant
-watch for adverse effect
-lifetime Rx is prob. required |
| adverse effect of Li | -category D for preg: congential cardiac malformations in 1st trimester
-diarrhea, disturbances in fluid homeosasis (edema, thirst, urinary frequency)
-decr. in thyroid hormone secretion |
| acute toxic of Li | 2.0mEq/L in young adults
1.5mEq/L in elderly
-NV
-cardiac arrythmias, conduction deficits
-renal failure |
| adverse drug interactions with Li | plasma Li level increase & decrease renal clearance
-thiazide diuretics, ACE inhibitors, NSAIDS |
| Valproic Acid | -as effective as lithium for acute mania (alternative to Li)
-sodium valproate or divalproex
-pregnancy D: neural tube defects
-effective in maintenance +/- lithium or neuroleptic |
| Carbamazepine | -acute mania in some lithium non-responders
-effective in maintenance +/- lithium or neuropletic
-Major Advese: sedation, N/V, pancytopenia
-hypersensitivity/ rashes
-pregnancy D: cleft lip, palate, facial dysmorphias |
| Lamotrigine | effective alone in bipolar depression but NOT MANIA
effective in maintenance (+ lithium)-mainly used for maintenance
-slow titration needed
- no effect on acute mania
-ADVERSE: sedation, Stevens-Johnson (rashes)
-pregnancy "C" |
| mechansims | not clear; but they are all sodium blockers, we don't know why other Na blockers don't work |
