Bipolar Flashcards
(23 cards)
Manic episode
abnormal, persistently elevated mood along with rapid speech, increased motor and speech activity, irritability, distractibility, decreased sleep, grandiose ideas, possible hallucination and delusions
Hypomania
at least 4 days of elevated/irritable mood combined with over-activity
Bipolar (1+2)
manic episodes or phases accompanied by major depressive disorder or episodes
Pathophysiology
unclear, but appears to be dysregulation in dopamine and serotonin systems
Dopamine
Theories linking BD and dopamine receptors within reward centers of the brain
Possible behavioral sensitization that makes individuals with BD more sensitive to dopamines effects
Serotonin
Decreases sensitivity of serotonin receptors
Exact nature of dyreg unclear
Altered brain regions
Limbic-cortical dysfunction
Elevated amygdala
Neural Activity
Limbic-cortical dysfunction
Hyperactivity of amygdala along with above avg volume
Diminished activity of hippocampus and prefrontal cortex
Smaller volume in prefrontal cortex, BP, hippo, ant cingulate
Elevated Amygdala
emotional sensitivity
while diminished cortical region activity - impaired planning, goal pursuit –> leading to low capacity to regulate emotion
Neural activity appears to change with episode status
during mania individuals appear to be less sensitive to negative stimuli
Overall treatment
Acute depression episode:
1. SSRI, bupropion
2. ECT, MAOI, TCA
Acute manic episode:
1. Lithium, valproic acid, carbamezapine (bzd)
2. Verapamil, ECT
Maintenance Treatment:
1. Lithium, valproic acid, carbamezapine (+)
2. education and structures psychosocial support
monitor
antidepressants can trigger a manic episode, especially TCAs
Lithium MOA
not precisely known, many theories on multiple pathways
Lithium 2 Roles
- Management of the acute manic or hypomanic episode
- may take 5-10 days for response, often combined with BZDs - Prevention of further manic and depressive episodes
Lithium can decrease
Suicide
Very effecive, but has many AE
Lithium AEs
GI (N/V/D, cramps)
Weight gain
Polydipsia & Polyuria
CNS: mental dullness, decrease memory + concentration, fine hand tremor, fatigue, muscle weakness
Lithium Toxicity
requires frequent plasma concentration monitoring
Toxicity Boxed warning
Toxicity related to serum concentrations and can occur at doses close to therapeutic levels
Refer if: persistent diarrhea, vomiting, coarse tremor, mild ataxia, drowsy, muscular weakness
Circumstances may alter concentrations and increase risk of toxicity: medical illness (D/V), diets, exercise, hot, surgery, age, pregnancy
Toxicity Education Point
maintain adequate hydration and consistent Na+ intake
Toxicity also associated with
many DDI, so carefully monitor drug regimen changes
Lithium side effect mneumonic
L: levels (monitor 2-4 x yr)
I: increased urination
T: thirsty, tremors
H: hair thinning, hypothyroidism
I: interactions (nsaids, diuretics)
U: upset stomach
M: muscle weakness
S: skin
Anticonvulsant Mediations
Valproic acid, Carbamazepine = anti-seizure drugs
Specific agents for acute manic episodes, mixed episodes and maintenance treatment.
Be aware of dermatologic reactions
- IMMEDIATELY refer - many rashes benign but it is not possible to reliably predict which will be benign vs. serious
BPD rehab concerns
Lithium has significant AEs and potential for toxicity
- Common: tremors, nystagmus, weakness/twitching, hyperreflexia
- osteoporosis
Be aware of changes in symptoms, worsening of condition:
- pt may cycle through different moods
- direct pt to psychiatrist before behaviors become more difficult to manage
