Rx Note

Introduction Bipolar disorder is characterized by recurrent episodes of elevated or irritable mood and depression , accompanied by changes in sleep and energy and associated with cognitive, physical and behavioural symptoms. Bipolar I disorder is characterized by at least 1 episode of mania , and usually episodes of depression and/or hypomania. Bipolar II disorder is characterized by a history of major depressive episodes and hypomanic episodes only, without episodes of mania. Bipolar disorder has a strong genetic basis and a peak onset in young people . Management Consider mood stabilizers (e.g. lithium or valproate) and second-generation antipsychotics (e.g. quetiapine, lurasidone, aripiprazole, olanzapine, risperidone) for the primary treatment of bipolar disorder. For maintenance treatment of bipolar disorder, aim for the highest tolerable lithium plasma level in the range of 0.6-0.8 mmol/L. Reduce to 0.4-0.6 mmol/L in case of good response but poor tolerance, or Increase to 0.8...

Introduction People with major depression typically have a low mood, loss of interest and enjoyment in activities, and other psychological and somatic symptoms. Somatic symptoms Changes to weight Psychomotor disturbance (agitation or retardation) Fatigue and sleep disturbance (either insomnia or hypersomnia) Psychological symptoms Diminished concentration Low self-esteem Excessive guilt Feelings of hopelessness and helplessness Suicidal thoughts or ambivalence about living NOTE: Please consult the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) [primary reference] or International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) for complete diagnostic criteria. Management Psychoeducation should be accompanied by support to help the patient modify their lifestyle, if necessary. Lifestyle modification can include improving sleep hygiene , undertaking adequate physical activity (exercise), consuming a healthy diet, minimising alcohol cons...