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Bipolar Disorder (MANIA) - Coggle Diagram
Bipolar Disorder (MANIA)
Medications
Lithium
Effective with?
depressive symptoms
Some (not great)
Rapid cyclers?
seldom
anticonvulsants are 1st line
Therapeutic windows
narrow
Therapeutic range: 0.5-1.2 mEq/L
Acute phase:
0.8-1.2 mEq/L
maintenance phase:
0.6-1.2 mEq/L
Labs:
draw as trough, 12 hours after administration
Before initiating:
Thyroid pain
creatinine
BUN
Urinalysis
CBC
EKG (50+)
Response seen:
1-2 weeks
Side effects
Endocrine
Weight gain
impaired thyroid function
diabetes insipidus
CNS
fine hand tremors
fatigue
fasciculations
mental cloudiness
headaches
nystagmus
Dermatological
maculopapular rash
pruritis
acne
Gastrointestinal
GI upset
diarrhea
vomiting
cramps
anorexia
Renal
Polyuria
polydipsia
edema
microscopic tubular change
diabetes insipidus
Cardiac
T-wave inversions
dysrhythmias
Hematological
Leukocytosis
Toxicity
coarse hand tremors
Signs/symptoms
slurred speech
confusion
severe GI
Dosing
Acute treatment
1200-2400 mg/day
maintenance
900-1200 mg/day
Pregnancy
AVOID
Ebstein's Anomaly
Gold standard for treating manic episodes
carbamazepine (Tegretol)
Pregnancy
Avoid
Dosing
400-1600 mg/day
Carbamazepine ER (Equetro)
200-1600 mg/day
no need to obtain blood levels
transient decreases
platelets
WBCs
rare
Therapeutic levels
6-12 mcg/mL
Side Effects
agranulocytosis
aplastic anemia
Labs
LFTs
Valproic Acid
Effectiveness
Rapid cycling
mixed bipolar
Labs
LFTs
Loading dose:
20 mg/kg
Therapeutic level
50-125 mcg/ml
Lamotrigine (Lamictal)
Dosing
Titrate slowly
leukoenia
risk of rashes
Effectiveness
depressive phase of bipolar
Side Effects
Steven Johnson's Syndrome
Fever
body aches
rash
tongue/oral swelling
topiramate (Topamax)
"Dopamax" - causes confusion
Effects
decreases BC efficacy
decreases digonix
Labs
Kidney stones
glaucoma
oxcarbazepine (Trileptal)
Side Effect
hyponatremia
decreases BC efficacy
Dosing
300-2500 mg/day
levetiracetam (Keppra)
Monitoring
Anemia (rare)
no need for blood monitoring
Other meds that may cause manic symptoms
captoril
cimetidine
corticosteroids
cyclosproine
disulfram
hydralizine
Isoniazid
Co-morbidities
hypothyroidism
substance abuse
adolescent vs Adult presentation
adolesecent
antisocial behavior
substance abuse
truency
failing grades
Scales
Young Mania Rating Scale (YMRS)
Mood Disorder Questionnaire (MDQ)
Pathology
tuberoinfundibular pathway
cause of hypersexuality
regulation of prolactin (acts on pituitary)
triggers (potential)
ECT
light therapy
antidepressants
withdrawal from
ampehtamines
cocaine
hallucinogens
opiates
Endocrine disorders
hyperthyroidism
Onset
40+
a medical condition
Rapid Cycling
Antidepressants accelerate
90% are women
DSM
Recurrent shifts in polarity
4+ mood episodes during previous 12 months
Types
Type I
one or more manic or mixed episodes
Type II
one or more depressive episodes
with at least 1 hypomanic episode
hypomania
briefer in duration
not as severe
no hospitalization
no significant functional impairments
Mania
Duration: Several days to several months
DIGFAST
Distractibility
Indescretion
Grandiosity
flight of ideas
Activities
Sleep deficit
Talkativeness