A 30-year-old pregnant woman comes to your clinic with decreased sleep, increased appetite and hyperactivity for last 2 weeks. A diagnosis of mania is made. Fuher probing reveals four episodes of major depression in the past two years. What drug will you prescribe to this patient?
High-Yield Explanation
Bipolar disorder - Bipolar disorder is characterized by marked mood swings between mania (mood elevation) and bipolar depression that cause significant personal distress or social dysfunction Bipolar I - mania + depression Bipolar II - depression + hypomania Mania: Decrease need for sleep Over talkativeness Abnormally increase activity levels Distractibility Increase self-esteem or grandiosity Flight of ideas Excessive involvement in pleasurable activities that have a high potential for painful consequences Duration - 7 days Hypomania - Less severe symptoms than mania Duration - 4 days Treatment:- Acute mania - mood stabilizer + antipsychotic >only antipsychotic In pregnancy antipsychotic is preferred because most of mood stabilizer are teratogenic Mood stabilizer - lithium (D/O/C for acute mania, causes ebstein's anomaly), valproate (most teratogenic), carbamazepine