Materials for Bipolar Disorder for DSM II

• 1) decreased need for sleep
• 2) elevated mood
• 3) unusual irritability
• 4) grandiosity
• 5) increased sexual desire
• 6) flight of ideas

• 1) depressed mood
• 2) diminished interest/pleasure
• 3) significant weight loss/gain
• 4) decreased concentration
• 5) suicidal ideation
• 6) hypersomnia/insomnia

• 1) more psychosis
• 2) more likely to require hospitalization
• 3) easier to treat

• 1) more common in women
• 2) difficult to treat

• 1) lithium (Lithobid, Eskalith)
• 2) valproate (Depakene, Stavzor, Depakote, Divalproex)
• 3) SGA's - atypical antipsychotics

• 1) lithium (Lithobid, Eskalith)
• 2) aripiprazole (Abilify)
• 3) quetiapine XR (Seroquel)
• 4) lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal XR)

Pregnancy Category D

Based on human data, the drug can cause fetal harm when administered to pregnant women, but the potential benefits from the use of the drug may be acceptable, despite its potential risks.

100% renally

0.8 - 1.2 mEq/L (trough level)

• 1) BMP
• 2) Renal function
• 3) thyroid function

• 1) decreased salt intake
• 2) NSAIDs
• 3) ACEIs
• 4) ARBs
• 5) dehydration
•   a. caution with diuretics
• 6) metronidazole

• 1) increased salt intake
• 2) caffeine
• 3) theophylline

• 1) SSRIs
• 2) SNRIs
• 3) triptans
• 4) linesolid
• 5) other serotonergic drugs

• 1) GI upset
• 2) cognitive effects
• 3) cogwheel rigidity
• 4) fine hand tremor
• 5) weight gain
• 6) polyuria
• 7) polydipsia
• 8) hypothyroidism

• 1) coarse hand tremor
• 2) vomiting
• 3) persistent diarrhea
• 4) confusion
• 5) ataxia

• 1) CNS depression
• 2) arrhythmia
• 3) seizures
• 4) irreversible brain damage
• 5) coma
• 6) mortality

Pregnancy category D

• 1) hepatic failure
• 2) teratogenicity
• 3) pancreatitis

50 - 125 mcg/mL

• 1) GI upset
• 2) alopecia
• 3) sedation
• 4) tremor
• 5) weight gain
• 6) thrombocytopenia

• 1) selenium
• 2) zinc

• 1) LFTs
• 2) CBC
• 3) platelets

No. If you want to switch to Depakote ER, the dose must be increased by 8-20%.

• 1) aripiprazole (Abilify)
• 2) quetiapine extended-release (Seroquel XR)
• 3) ziprasidone (Geodon)
• 4) risperidone (Risperdal)

• 1) manic & mixed symptoms
• 2) maintenance

15 - 30 mg QAM

• 1) akathisia
• 2) restlessness
• 3) insomnia
• 4) constipation
• 5) fatigue
• 6) blurred vision

• 1) dyslipidemia
• 2) weight gain
• 3) diabetes
• 4) NMS
• 5) TD
• 6) leukopenia
• 7) neutropenia
• 8) agranulocytosis
• 9) orthostasis/dizziness

• Stand alone agent:
• 1) bipolar depression
• Concurrent use with lithium or Divalproex:
• 1) mania
• 2) maintenance

400 - 800 mg QHS

300 mg QHS

• 1) sedation
• 2) dry mouth
• 3) constipation
• 4) dizziness
• 5) increased appetite
• 6) weight gain
• 7) nausea

• Stand alone agent:
• 1) manic & mixed episodes
• Concurrent use with lithium or valproate:
• 1) maintenance

40 mg BID

80 mg BID

• 1) QT risk
• 2) numbs mouth
• 3) sedation
• 4) dizziness
• 5) weight gain

• Alone or with lithium or valproic acid:
• 1) acute mania
• 2) mixed episodes

2 - 3 mg/day

6 mg

1) 0.5 mg/day

• 1) tablets
• 2) oral solution
• 3) M-tabs

• 1) sedation
• 2) increased appetite
• 3) fatigue
• 4) insomnia
• 5) parkinsonism
• 6) akathisia
• 7) nausea
• 8) some QT risk

Pregnancy category C

• 1) Animal reproduction studies have shown an adverse effect on the fetus.  There are no adequate and well-controlled studies in humans and the benefits from the use of the drug in pregnant women may be acceptable, despite its potential risks.
• 2) Animal reproduction studies have not been conducted.

• 1) Serious skin reactions
• 2) SJS
• 3) TEN
• 4) increased risk with high starting doses
• 5) rapid increases
• 6) co-administration of valproic acids
•   a. increases lamotrigine (LaMICtal, LaMICtal ODT, LaMICtal CD, LaMICtal XR) level by more than two-fold

Stevens-Johnson Syndome: formation of purpuric macules and targetoid lesions. Full-thickness epidermal necrosis occurs, with lesser detachment of the cutaneous surface.  Drugs are the most common affiliant of this state, however it may be due to infection as well. The mortality rate is lower than the cases with TEN.

Toxic epidermal necrolysis: is an acute disorder characterized by widespread erythematous macules and targetoid lesions.  Full-thickness epidermal necrosis occurs, and involves more than 30% of the cutaneous surface. The mucous membrane are commonly involved. The mortality rate is higher than in cases with SJS.

follow the titration schedule for the first five weeks

• 1) diplopia
• 2) sedation
• 3) ataxia
• 4) headache

• 1) Divalproex
• 2) Valproate (Depakete, Depakone, Stavzor)