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21 Cards in this Set

  • Front
  • Back
what are some of the medical conditions that may induce mania?
1. CNS disorders (MS, SLE, Brain tumor, stroke)
2. Infections (sepsis, HIV, neurosyphillis
3. electrolyte or metabolic abnormalities (hypo,hyper glycemia, Na or Ca fluctuations.
4. Vitamins and nutritional deficiences (b12, a.a. essential fatty acids)
What ar some drugs that many induce mania.
1. Alcohol intoxication
2. Drug w/drawal.
3. Antidepressants
4. Agents that augment DA OR NE.
6. MJ intoxication
7. Steriods
8. thyroid preparations
9. Xanthines (caffeine, theophylline)
10. OTC weight loss agents and decongestants.
11. herbal products
12. Bright ligh therapy
13. Sleep deprivation
What are the criteria for manic episodes?
>1 wk of abnormal or persistent elevated mood with at least 3 of the following (4 if irritable):
1. Distractability (poor attention)
2. Insomnia
3. Grandiosity (inflated self-esteem)
4. Flights of Ideas/racing thoughts
5. Activity
6. Speech
7. Thoughtlessness
What is severe mania or depression?
1. reflects the extreme mood state the patient is experiencing:
delusion of grandiosty
Delusions of guilt or worthlessness
What is the criteria for hypomania?
At least 4 days of abnormal and persistent elevated, expansive, irritable mood associated with at least 3 of the following:
Flights of ideas
Speech (Pressured)

What is the hallmark sx of RAPID CYCLING?
FREQ or severe depression.

> or equal to 4 episodes of major depressive or manic episodes (manic, mixed, hypomanic) in 12 months.
How is mixed episode characterized?
1. meet criteria of both mdd and a ma monic episode which occurs nearly every day for at least one week.
2. femailes more common.
What are some of the non-pharm tx that could be used for bipolar disorders:
1. Ensure adequate sleep, nutrition, and stress reduction.
2. ECT
3. Bright light therapy
4. Excercise
5. Enviromental modification
6. Utilize adjunctive psychotherapy (individual, group, family), education, counseling.
What are some pharmcological agents used for MOOD stabilizers?
First line therapy:
- Monotherapy with a mood stabilizer is optimal for maintenance tx.
- tx:
1. Li
2. Valproic Acid
3. Carbamazepine
4. Lamotrigine
Lithium used for bipolar as what?
First Line therapy FDA approved for acute mania and maintenace tx.
- for children and adults over 12 yrs old
- Add BZD until Li reaches steady state.
- Also effective in preventing and txing depression.

Long-term use reduces suicide risk 8 to 10 fold and prevents recurrent episodes of illness.
What are some of the DD interactions?
- DI: renal elimination.
- Caffeine, theophylline, acetazolamide decrease Li.
- Thiazides, NSAIDS, ACE-I, verapamil, diltiazem, salt restricted diets--> increase LI.
- additive neurotoxic effects w/ antipsychotics and antiepileptics.
Li a.e.:
1. tremor,
2. n/v (take with food)
3. weight gain
4. polydipsia/uria (nephrogenic diabetes insipidus)
Lithium is Narrow therapeutic window...levels to maintain serum conc.
- 0.6 to 1.2 meq/L for maint.
- 0.8 to 1.2 meq/L for acute episodes.
Lithium toxicity:
Moderate toxicity (levels>1.5
1. reappearance of GI Sx.
2. severe hand tremor
3. confusion
4. hypothyroidism
5. ataxia
6. drowsiness
7. slurred speech

> 2 mEq/L:
- seizures
- CV collapse
- Coma
- Death.
Valproic Acid
First line agents: rapid cycling, mixed episodes, co-morbid substance abuse
- used in mania and main.
Valproic Acid Drug Interactions:
asa -> VPA -> WARFARIN
- VPA increased by cimetidine, chlorpromazine, erthromycin, fluoxetine.
- Inhibits metabolism of carba and lamotrigine.
- INCEARSE conc. of other anticonvulsants and TCAs
Monitoring Therapy: for vPA
- Teratogenicity: 1g/day for VPA monotherapy during pregnancy linked to 4-fold increased risk of congenital malformations
Carbamazepine (Tegretrol, carbatrol)
USED 2nd line:
- rapid cyclers, mixed states, Lithium- refractory patients.
- used in acute mania
Drug Interactions: Carba:

Teratogencity: category D
Clozapine: increased bone marrow suppression
- Decreased levels/efficacy of oral conctraceptives, warfarin, VPA, lamotrigine,
Lamotrigine (Lamicatal)
inhibit Na channels and glutamate release
FDA: approved for maintenance tx.
1.Black Box Warning: SJS
2. Titrate dose slowly
--2nd line maintenance therapy
- used to manage severe psychotic sx and behavioral disturbances during acute mania.
- Symbyax - bipolar depression
- black box warning for suicidality.
contraindicated w/ MAOi usage.

Risperdal for BIPOLAR MANIA
- short term tx associated with BPI in children and adolsecents 10 to 17 yrs. old