bipolar disoreder

[Audio] Bipolar Disorder. Bipolar Disorder.

[Audio] Introduction to Bipolar Disorder Bipolar disorder Characterized by episodes of mania, hypomania, and depression. Hypomania Definition: Similar to mania but less severe. No psychotic symptoms and does not require hospitalization. Duration: At least 4 consecutive days with persistent elevated/irritable mood and increased energy. is a chronic, recurrent mood disorder affecting 1–2% of the population..

[Audio] Classification of Bipolar Disorder Type Features Bipolar I At least one manic episode ± depressive episodes Bipolar II At least one hypomanic episode + depressive episodes (no full mania) Cyclothymic Disorder Recurrent hypomanic & subthreshold depressive symptoms Substance/Medication-Induced Bipolar symptoms triggered by drugs Other Specified/Unspecified Atypical presentations.

[Audio] Description of Bipolar Disorder Episodes Manic Episode Mood: Abnormally elevated, expansive, or irritable. Duration: At least 1 week, most of the day, nearly every day. Symptoms (≥3 required, 4 if mood is irritable): Grandiosity: Inflated self-esteem, delusions of power. Decreased sleep need: Feels rested after only a few hours. Talkativeness: Pressured, rapid speech. Flight of ideas: Racing thoughts, jumping topics. Distractibility: Inability to focus. Increased goal-directed activity: Hyperproductivity. Risky behaviors: Reckless spending, hypersexuality. Hypomanic Episode Same as mania, but milder and not disabling. No psychotic symptoms. Duration: At least 4 days. Major Depressive Episode At least 2 weeks of depressed mood or anhedonia (loss of interest/pleasure). Symptoms (≥4 required): Insomnia/hypersomnia Weight changes Fatigue, loss of energy Psychomotor retardation/agitation Feelings of worthlessness/guilt Difficulty concentrating Suicidal ideation Mixed Features Manic/hypomanic episode with ≥3 depressive symptoms. Depressive episode with ≥3 manic symptoms..

[Audio] Diagnosis & Pharmacist’s Role Mood Disorder Questionnaire (MDQ): Screening tool used by pharmacists. Self-administered, 13 questions. Positive if: ≥7 "yes" answers + moderate/severe impairment. How to use it: Give patient the MDQ form. Ensure accurate self-reporting. If positive, refer for psychiatric evaluation..

[Audio] Goals of Therapy Control acute symptoms (mania, depression). Prevent recurrence & relapse. Treat comorbid conditions (substance use, anxiety). Improve cognition & quality of life..

[Audio] Non-Pharmacologic Treatment Psychoeducation Cognitive-Behavioral Therapy (CBT) Family Therapy Mood Tracking Apps (eMoods, CREST.BD).

[Audio] Overview of Pharmacologic Treatment Mood Stabilizers: Lithium, Valproate, Lamotrigine. Atypical Antipsychotics: Quetiapine, Lurasidone, Aripiprazole. Adjuncts: Benzodiazepines, Antidepressants (cautious use)..

[Audio] First-Line Medications for Mania Drug Dose Common Side Effects Rare Side Effects Serious Side Effects Lithium 300 mg BID Tremor, weight gain Hypothyroidism Kidney dysfunction, toxicity Divalproex 250 mg TID GI upset Hair loss, pancreatitis Liver failure, thrombocytopenia Quetiapine 50 mg BID Sedation, weight gain Cataracts Neuroleptic Malignant Syndrome (NMS) Aripiprazole 15 mg/day Akathisia Impulse control issues Severe EPS, tardive dyskinesia.

[Audio] Lithium Drug Interactions & Management Increased lithium levels: NSAIDs, ACE inhibitors, diuretics (esp. thiazides) → Nephrotoxicity risk. Decreased lithium levels: High salt intake, caffeine, theophylline → Reduced effectiveness. Management: Monitor serum lithium (0.8–1.0 mmol/L in mania). Side Effect Management Tremor: Lower dose, add propranolol. Polyuria: Switch to once-daily dosing. Hypothyroidism: Supplement with levothyroxine..

[Audio] First-Line Medications for Depression Drug Dose Common Side Effects Rare Side Effects Serious Side Effects Precautions Quetiapine 50 mg/day Sedation Cataracts NMS Monitor glucose/lipids Lurasidone 20 mg/day Akathisia EPS Stroke (elderly) Take with food Lamotrigine 25 mg/day Rash SJS Aseptic meningitis Slow titration required.

[Audio] Managing Medication Side Effects Weight Gain (SGAs): Metformin (off-label), lifestyle changes. Tremor (Lithium): Lower dose, propranolol. EPS (Antipsychotics): Benztropine, amantadine..

[Audio] Treatment Algorithm for Bipolar Step 1: Initial Assessment Assess suicidality → If high risk → Hospitalization or ECT. Check for mixed features (e.g., agitation, racing thoughts) → If present → Avoid antidepressants. Assess comorbidities (e.g., anxiety, substance use) → Modify treatment accordingly. Evaluate current medications (stop antidepressants if mania risk is high). Step 2: First-Line Monotherapy Choices Quetiapine: 300 mg/day (sedation risk, monitor weight and glucose). Lurasidone: 20–60 mg/day (must take with food, risk of EPS). Lithium: 600–1800 mg/day (monitor kidney, thyroid, lithium levels). Lamotrigine: Slow titration to 100–300 mg/day (risk of Stevens-Johnson Syndrome, requires gradual dose increase)..

[Audio] Treatment Algorithm for Bipolar - cont. Step 3: If Partial Response After 4 Weeks Add another first-line agent (e.g., lithium + quetiapine). Consider lamotrigine as an adjunct (if not already used). Lurasidone + lithium/divalproex (if tolerable). Step 4: If No Response After 6–8 Weeks Second-line options: Olanzapine + Fluoxetine (high metabolic risk). Adjunctive SSRIs or Bupropion (cautiously, monitor for manic switch). ECT (Electroconvulsive Therapy) for severe cases. IV Ketamine (emerging treatment, limited evidence in bipolar depression). Expected Response Timeline Partial improvement: 2–4 weeks. Full response: 6–8 weeks (longer than mania treatment)..

[Audio] Lab Tests for Monitoring Medication Monitoring Tests Frequency Lithium Lithium levels, renal function, thyroid function Every 3–6 months Divalproex Liver function (LFTs), CBC (platelets) Every 3 months SGAs (Quetiapine, Lurasidone, Olanzapine) Glucose, lipid profile, weight, BP Every 6 months Lamotrigine Rash monitoring (SJS risk) At every dose increase.

[Audio] Maintenance Therapy for Bipolar Disorder Who Needs Maintenance Therapy? Patients with ≥2 mood episodes. Severe episodes requiring hospitalization. Rapid cycling bipolar disorder (≥4 episodes/year)..

[Audio] First-Line Maintenance Medications Drug Preferred For Key Monitoring Lithium Prevents manic & depressive relapses Kidney function, thyroid function, lithium levels Quetiapine Good for both manic & depressive prevention Glucose, lipids, weight, BP Divalproex Strong anti-manic properties LFTs, platelets, weight Lamotrigine Best for depressive relapse prevention Rash monitoring.

[Audio] Second-Line Maintenance Options Olanzapine (High metabolic risk, use with caution). Risperidone Long-Acting Injection (LAI) (Useful if poor adherence). Carbamazepine (Many drug interactions, used less often). Duration of Maintenance Therapy First-episode bipolar patients: At least 2 years. Multiple relapses: Lifetime treatment recommended..

[Audio] Special Populations in Bipolar Disorder 1. Bipolar Disorder in Pregnancy & Breastfeeding High risk of relapse postpartum → Close monitoring required. Safe Options: Lamotrigine (best studied for bipolar depression). Quetiapine (considered safer among SGAs). Avoid in Pregnancy: Valproate & Carbamazepine → Teratogenic (Neural tube defects). Lithium → Ebstein’s anomaly (1st trimester). 2. Bipolar Disorder in Elderly Patients Higher sensitivity to side effects (falls, cognitive decline). Preferred Medications: Lithium (lower dose, 0.5–0.8 mmol/L range). Quetiapine (less risk of EPS than other antipsychotics). Lamotrigine (better tolerated than valproate). Avoid: Anticholinergic medications (can worsen cognition). High-dose antipsychotics (stroke risk in elderly). 3. Bipolar Disorder in Adolescents & Children First-line treatment for mania: Lithium, Quetiapine, Risperidone, Aripiprazole. First-line treatment for depression: Lurasidone, Lithium, Lamotrigine..

[Audio] Role of the Pharmacist in Bipolar Disorder 1. Medication Counseling & Adherence Educate patients on the importance of lifelong therapy. Address concerns about side effects, drug interactions, and metabolic risks. Encourage mood tracking apps (eMoods, CREST.BD)..

[Audio] Role of the Pharmacist in Bipolar Disorder-cont. 2. Monitoring & Side Effect Management Medication Common Monitoring Issues Pharmacist’s Role Lithium Kidney, thyroid function, dehydration Educate on hydration, avoid NSAIDs Divalproex Liver toxicity, weight gain Recommend regular LFTs, weight monitoring SGAs (Quetiapine, Lurasidone, Olanzapine) Metabolic syndrome, EPS Monitor glucose, lipids, weight, movement disorders Lamotrigine Rash (Stevens-Johnson Syndrome) Slow titration, warn about early rash signs.

[Audio] Role of the Pharmacist in Bipolar Disorder-cont. 3. Drug-Drug Interaction Monitoring Medication Drug Interaction Effect Pharmacist’s Advice Lithium NSAIDs, Diuretics Increased lithium levels Avoid or monitor lithium levels Divalproex Warfarin, Lamotrigine Increased bleeding risk, SJS risk Lower dose of lamotrigine SGAs Metformin, Antihypertensives Increased risk of weight gain, hypotension Monitor glucose, BP.

[Audio] Summary Key Takeaways Bipolar disorder is a lifelong condition requiring continuous treatment. Pharmacists play a vital role in medication adherence, side effect monitoring, and drug interactions. Early recognition and management of side effects improve treatment outcomes. Monitoring metabolic, renal, and hepatic functions is crucial for long-term therapy..