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Bipolar Disorder (Epidemiology (Smoking in mental illness (May use…
Bipolar Disorder
Epidemiology
4.5% prevalence in the US
Sx begin in late adolescence/early adulthood
BP 1 is sex-equal; BP2 more in F
Etiology unknown
Family, twin, adoption studies show ^ association
Neuroimaging shows some association
Smoking in
mental illness
May use tobacco to mask sx/ADRs
Nicotine can improve attention/concentration
Anxiety
Treatment
Goals
Elminate episode w/ complete remission of sx
Prevent recurrences or relapses in episode
Return to baseline psychosocial functioning
Maximize adherence
Minimize ADRs
treat substance use/abuse
minimize nicotine + caffeine at least 8h before bed
Avoid stressors/substances that induce episode
Monitor for
Episodes + sx
Med adherence
ADRs, esp. sedation & wt gain
Suicidal ideation or attempts
Mood stabilizer (lifetime)
1st-line:
lithium
(trial 4-6 weeks)
sodium restriction (hot weather, exercise), dehydration, vomiting, diarrhea, age 50+, HF, cirrhosis, DDIs all impact [lithium]
Monitoring
Normal serum lithium 0.6 to 1.2 mEq/L
toxicity at >1.5 to 2
GI
Coordination
Cognition
Treat w/ ED visit, d/c, gastric lavage & IV fluids, dialysis if lithium >4
DDIs
Thiazides, NSAIDs, COX-2i, ACEi, neurotox with antipsychotics, phenytoin, verapamil, CCB. caffeine & theophylline enhance renal Cl
Adjunctive agents: antidepressants
valproate
avoid in pregnancy :forbidden:
carbamazepine
avoid in pregnancy :forbidden:
lamotrigine
DDI with valproate: V inc serum lamotr; decr L dose by 50% when combined
Acute episodes
lithium
valproate
ER carbamazepine
aripiprazole
olanzapine
cariprazine
Quetiapine
Risperidone
Ziprasidone
Benzos
hi-potency: clonazepam & lorazepam (IM)
Cause minimal ADRs and sedate quickly
ADRs :warning:
FGAs: higher risk of EPS
SGAs: higher risk of metabolic side effects
Non-pharm treatment
Adequate nutrition
sleep
exercise
stress reduction
therapy
PathoPhys
Environmental stressors
Psychosocial stressors
Sleep dysregulation
secondary causes of mania
medical illness
medications
substance intoxication
withdrawal
Clinical presentation
Hx of mania or hypomania that is not caused by any other medical condition, substance, or psychiatric disorder
5 subtypes
BP 1: manic episode +/- hypomanic/depressive episode
BP 2 major depressive episode + hypomanic episode
Cyclothymic disorder Chronic fluctuations (could be 1-2 yrs of each, trend shorter for children)
Other specified bipolar and related disorder
Dysthymia
Onset in early childhood
more mood episodes
rapid cycling
comorbid psych conditions
likelier fam hx
Rapid cycling
4 mood episodes per year
more common in women
Frequent/severe depression
More common in children/younger onset disease