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Flashcards in Bipolar Deck (20):

bipolar disorder

episodes of major depression interspersed w. periods of mania or hypomania


Manic episode

period of abnormally elevated or irritable mood lasting at least 1 week: inflated self esteem, dec need for sleep, talkative, racing thoughts, distractability, dec judgement, hard to treat



less exaggerated form of mania


Pathophysiology of bipolar disorder

changes in the limbic system, basal ganglia, and hypothalamus leads to dysregulation of neurotransmitter systems, fluctuations in norepi/DA, fluct in intracerebral ca level, endocrine dysfunction, fam hx, environment


Bipolar 1

mood disorder w/ 1 manic/hypomanic and 1 depressive episode, episodes are followed by sx free periods


Bipolar 2

major, recurrent depressive episodes w/ hypomania, suicidal thoughts, usually does not require hospitalization


Clinical course of bipolar

1st episode usually Manic, untreated episodes can last for months, most have multiple episodes


Goal of Tx

control sx, reduce frequency of cycling, cure is not realistic, likely lifelong therapy, use BZD and antipsychotics for acute episodes


TX options

mood stabilizers- lithium, anticonvulsants- valproate, carbamazepine, lamotrigine, oxcarbazepine, AAPs, consider acute vs maintenance, current mood state, longitudinal hx of pt, comorbidities, side effects



gold standard, effective in classic mania w/ euphoria, 100% renally eliminated, long term maintence therapy but 30% do not respond, dec # and severity of episodes, lots Dis


Lithium MOA

mono-valent cation, Li, effects anion exchanges and Na transport in nerves, normalizes synaptic transmission of NE, 5HT, DA, takes 5-14 d onset


Lithium ADRs

tetatogenic cat X, early onset- polyuria, polydipsia, dry mouth, hand tremor, GI upset, HA, memory impairment, long term- polyuria, polydipsia, tremor, hypothyroidism, acne, EKG changes, inc WBC


Toxicity w/ Lithium

Mild- more severe hand tremor, GI, confusion, ataxia, slurred speech, mod-severe- muscle tremor, coma, seizure, hyperreflexia, CV colapse, death


Lithium advantages

will control manic pt w/out feeling drugged, will normalize mood, very good prevention to dec mood swings, less severe relapse, blood conc monitoring, cheap


Lithium disadvantages

narrow therapeutic range, pt compliance, toxicity knowledge, delayed onset, rapid cyclers are poor responders, expense of blood tests



3-5 d onset, more effective for rapid cyclers, mixed episodes, dose may be limited by GI, also sedation, minor elevations in LFTs, wt gain, hyperammonemia, hyperandrogenism syndrome in young females


Carbamazepine (Tegretol)

more effective for rapid cyclers, mixed episodes, 1-2 w onset, many DI, induces its own metabolism, good add on or 2nd line, sedation, N/V rash hypotension


Lamotrigine (Lamictal)

indicated for maintenance tx of BP 1 disorder, effective in depressive spectrum of bipolar disorders, not for a manic state, more effective as add-on


Other tx options

oxcarbazepine (but hypoNa), gabapentin, topiramate (good if migraines), AAP (all proven effective, use in addition to other agents


Treatment guidelines

lithium, VPA, CBZ, AP, short term BZDs, maintenance- monotherapy if possible, lithium, VPA, lamotrigine, depressed phase- use anti-depressants cautiously, flip into mania