blue_ocean

Treatment of BPAD: EMQ

11 posts in this topic

 A 45-year-old woman with a history of bipolar disorder presents with elated mood, excessive energy and disturbed behaviour. She is on venlafaxine 225 mg (Choose TWO) - 

 

  1. Stop antidepressant treatment
  2. Consider adding an antipsychotic
  3. Check compliance
  4. Check dose and increase if necessary 
  5. Consider adding lithium or valproate
  6. Check plasma levels
Edited by blue_ocean
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the answer is: consider adding lithium and valproate

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My understanding is the same. The answer should be 1 and 5. However they say it is 1 and 2. I thought to double check with you guys 

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Surprised by answer 2. 1 is ok. I believe they have to say, avoid using sodium valproate/lithium in a child bearing age. If antipsychotics is there in the option ,choose antipsychotic first.

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I have checked NICE Recommendations.

 1.5 Managing mania or hypomania in adults in secondary care

1.5.2 If a person develops mania or hypomania and is taking an antidepressant (as defined by the British national formulary [BNF]) as monotherapy:

consider stopping the antidepressant and

offer an antipsychotic as set out in recommendation 1.5.3, regardless of whether the antidepressant is stopped.

1.5.3 If a person develops mania or hypomania and is not taking an antipsychotic or mood stabiliser, offer haloperidol, olanzapine, quetiapine or risperidone, taking into account any advance statements, the person's preference and clinical context (including physical comorbidity, previous response to treatment and side effects). Follow the recommendations on using antipsychotics in section 1.10.

http://www.nice.org.uk/guidance/cg185/chapter/1-recommendations#managing-mania-or-hypomania-in-adults-in-secondary-care-2

So, 1 and 2 are correct.

 

Edited by Carole
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Thanks Carole. Well worth to post this question on the forum to clarify this. 

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On that note, remember this question as well.

 

Which of the following should be used as a first choice treatment in children and adolescents with acute manic or mixed episodes?

Olanzapine

Lithium 

Carbamazepine

Sodium valproate

Lamotrigine

 

Ans is: Olanzapine. 

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Hi blue_ocean,

According to the alternatives, Olanzapine would be the answer. However, would be Aripiprazol the best alternative if it was present?

http://pathways.nice.org.uk/pathways/bipolar-disorder#path=view%3A/pathways/bipolar-disorder/diagnosing-assessing-and-managing-bipolar-disorder-in-young-people-in-secondary-care.xml&content=view-node%3Anodes-treating-mania

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