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