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Flashcards in Bipolar Disorder Deck (26):
1

Bipolar is very hard to diagnose and often resembles the disease: ______

Depression

2

What is bipolar disorder?

patients experience episodes of extreme depression and then episodes of mania

3

What is very very very important with bipolar patients?

SLEEP CYCLE

4

Is the exact cause of bipolar known?

No

5

There has been evidence for imbalance of dysfunction of hormones, neuropeptides and many neurotransmitters. What are the neurotransmitters?

-dopamine
-NE
-serotonin
-melatonin
-GABA
-glutamate
-asparate
-acetylcholine

6

What types of medications have been most helpful?

meds which decrease neuron excitability

7

Describe the depressed phase of bipolar disorder

-often depressed episodes outnumber manic episodes
-more intense concern to the individual
-when people are reporting their symptoms themselves, they more commonly talk about depression over manic
-more frequent and more feared than manic episodes

8

_________ can switch a patient from a depressive episode into a manic one

antidepressants

9

If the depression side of bipolar disease is so much more severe, it would make sense to give them antidepressants, right?

NO! Antidepressants are avoided for many bipolar patients because they can switch a patient from a depressive episode into a manic one

10

Bipolar depression is very commonly confused with _____ ______

unipolar depression

*but these two are very different

11

Why is there a diagnostic dilemma between bipolar depression and unipolar depression?

Many patients will not recognize or devalue hypomanic or manic episodes so they may think they suffer from unipolar depression when in actuality they suffer from bipolar disorder.

12

What kind of medications are involved for bipolar disorder?

-benzodiazepines
-antipsychotics

13

____ ______ have the best evidence for long-term benefit

mood stabilizers

14

Describe the optimal long term management for BP disorder

mood stabilizer plus an antipsychotic along with non-pharm supports including sleep cycle management

15

What are some warning signs for the manic phase of BP disorder?

-mood changes
-increased energy/restlessness
-rapid and pressured speech
-impulsivity/ impaired judgement
-distractible
-irritable
-psychotic

16

Describe features of a mixed episode of bipolar disorder (mixed - symptoms of both depression phase and manic phase are present)

-simultaneous symptoms of depression and mania (frantic energy with hopelessness or guilt)
-anxiety/agitation
-desperation feeling impulsivity (SUICIDAL)

17

What kind of drugs can trigger a manic episode?

Drugs which increase neurotransmitters (5HT, NE, and DA)
*Glutamate levels are increased
*hormonal and CRH imbalance significant

18

What can be an effective treatment for a manic episode?

Anticonvulsants or calcium channel blockers

19

What is the difference between Bipolar 1 and Bipolar 2?

Both groups are subject to major depression.
-Bipolar 1 indicates at least one severe manic episode.
-Patients who experience less severe manic symptoms (hypomania) are considered to be Bipolar 2.

20

Describe signs that would indicate the prognosis of this disease has been improved after or during treatment.

-lack of rapid cycling
-little or no psychotic features, substance abuse, med problems, suicidal thoughts
-decent work history, shorter manic/depressive phases, absence of residual depressive symptoms when "well"

21

List some mood stabilizers in bipolar disorder

-lithium
-anticonvulsants
-antipsychotics
-calcium channel blockers ??

22

How does lithium work as a mood stabilizer?

-through two "second-messenger" systems (phosphatidylinositol and cAMP) membrane-mediated responses are slowed or normalized
-offsets the impact of excessive neurotransmitter release/activity
-indirect serotonergic enhancing effects can be really significant

23

How do anticonvulsants work as a mood stabilizer?

-ex. valproic acid - antagonizes glutamate, is a GABA agonist, supports neurodegenerative factors
-anticonvulsant effectiveness involves the dampening of excessive neurotransmission and NT's leading to increased control over impulses decreased potential for normal fluctuations in mood to become pathologic episodes

24

What are examples of some anticonvulsants?

-carbamazepine
-lamotrigine
-topiramate

25

Are anticonvulsants generally used as a long-term or short-term treatment for patients with BP disorder?

long-term

26

How do antipsychotics help to treat BP disorder?

-quite beneficial in treating acute mania