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Bipolar I and II Cheat Sheet by

psych     bipolar     pmhnp     mood

Bipolar I Criteria

1 or more manic/ mixed episode
Elevated, expansive, or irritable mood, and increased goal-d­­ir­ected activity or energy lasting ≥1 week (any duration if hospit­­al­i­zed), present most of the day, nearly every day

Bipolar II Criteria

Never had a full manic episode
At least 1 hypomanic episode and at least 1 major depressive episode
Distinct period of abnormally and persis­­tently elevated, expansive, or irritable mood, and increased goal-d­­ir­ected activity or energy lasting ≥4 but <7 days, and clearly different from usual nondep­­ressed mood, present most of the day, nearly every day
Not severe enough to cause marked impair­­ment, not due to substance or medical condition, and no psychosis

Bipolar I and II- 3 or more of the following

Grandi­osity
Decreased sleep
Pressured speech
Racing thoughts
Distra­cti­bility
Increased activity
Excessive pleasu­rable activi­ties/ risk taking
4 required if irritable mood only
 

Mania Sx- GIDDINESS

Grandiose
Increased activity
Decreased judgment and sleep
Delusional
Irritable
Non- attentive
Elevated mood and euphoria
Speedy speech
Speedy thoughts

Demogr­aphics

0.7% population at risk
2.3 million adults
Age of onset in 20s normally
= in males and females

Treatment Guidelines

Treat to remission regardless of the number of medica­­tions
Mood stabilizer or mood stabilizer + SGA
Discon­­tinue antide­­pr­e­s­sants
Relapse risk is highest in first few months after treatment initiation
Lithium gold standard- but less effective in rapid cycling and mixed episodes

Meds

Lithium
Depakote
Tegretol
Lamictal
SGAs (acute mania or psychosis)
 

Lithium

Normal level 0.5- 1.2 in acute phase
Normal level 0.6- 1.0 in mainte­­nance phase
Dose 1,200- 2,400mg in acute phase; 900- 1,200mg in mainte­­nance phase
SEs: weight gain, fine hand tremors, nausea, increased urination, thirst
Intera­­ct­ions: ACEs. ARBs, diuretics, NSAIDs, Topamax
Increase water intake
Antisu­­icidal properties
Toxicity: confusion, slurred speech, coarse hand tremors, severe GI effects
Avoid in pregnancy (espec­­ially 1st trimester)
Monitor KIDNEYS

Depakote

Normal level 50-125
Dosage 15- 50 mg/kg/ day
SEs: nausea diarrhea, abd cramps, sedation tremor, alopecia, liver issues
Rare: Stevens Johnson
Avoid in pregnancy
Intera­­ct­ions: Topamax (increased ammonium), tegretol (decreases levels of both drugs)
Increases levels of lamictal and SGAs
Monitor LIVER

Tegretol

Normal level 6- 12
Dose 10- 20 mg/kg/ day
SEs: nausea, dizziness, sedation, headaches, dry mouth, consti­­pa­tion, skin rash, liver issues
Rare: agranu­­lo­c­y­tosis/ aplastic anemia, Stevens- Johnson (In asians especially due to HLA-B 1502 allele)
Avoid in pregnancy
Monitor LIVER

Lamictal

No level
Dosage 25- 600mg/ day
SEs: dizziness, ataxia, somnol­­ence, diplopia, nausea, headache liver issues
Rares: Stevens- Johnson
Mainte­­nance only
Helps in depressive phases
Titrate super slow- 25mg q day x 2 weeks, then 50mg q day x 2 weeks etc
When added to depakote, lamictal level doubles
When added to tegretol, it is metabo­­lized quicker
Often added to Lithium, SGAs or antide­­pr­e­s­sants

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