Flashcards in Bipolar disorder Deck (20):
What is mania?
-distinct period of dramatically elevated, irritable mood lasting 1 week or more and impairing social function
- can include: inflated self-esteem, reduced need for sleep, verbosity, racing thoughts, distractibility, risky behaviour
What is hypomania?
brief duration of manic sx- less severe
What is bipolar disorder divided into?
Bipolar I and Bipolar II
What is bipolar I- who does it affect more?
- episodes of sustained mania, usually with intervening depressive episodes
- equal rate of females and males- onset of 21
What is bipolar II- who does it affect more?
- major depressive episodes with at least 1 manic episode
- more prevalent in females than males
What are the neurochemical theories of bipolar disorder? What is the consensus out of this?
- sensitization and kindling theory
- permissive serotonin hypothesis
- monoamine hypothesis
- cholinergic hypothesis
-- bottom line: there are multiple defects and no real solid grasp on the MOA
What are some non-pharm treatments of bipolar disorder?
- adjust sleep, nutrition, exercise, stress levels
What are the pharmacological treatments ?
- mood stabilizers
- atypical antipsychotics
- adjunct therapy with benzos
What drugs are known to control manic episodes?
- lithium, valproate, antipsychotics, benzos
How does lithium aid in bipolar disorder?
- 60-80% effective for manic phase
- it has several reported effects
-- reduced serotonin reuptake
-- reduced DA synthesis
-- increased GABAergic activity
-- increased glutamate
-- reduced neuronal calcium uptake
- major hypothesis is that lithium affects the IP3/DAG second messenger system by blocking inositol recycling
What are the adverse effects of lithium?
--> early: GI disturbances, muscle weakness, polydipsia with polyuria, nocturne, headache, confusion, tremor
--> long term: renal morphology changes, hypothyroidism and loiter, weight gain, reduces libido, sexual dysfunction, edema, severe acne, cardiovascular
What are the drug interactions of lithium?
- thiazide diuretics, NSAIDs, ACE inhibitors all increase Li
- potassium sparing diuretics reduce Li
- loop diuretics, Ca channel blockers may increase of decrease lithium
How does carbamazepine work in bipolar disorder?
- aids in manic, depression and maintenance
- similar efficacy to Li, better for rapid cycling
- adverse effects:
--- nausea, vomiting, diarrhea, hyponatremia, rash, leukopenia, fluid retention, drowsiness, dizziness, lethargy, headache
How does valproate work?
approved for anti-manic effects
- strong efficacy in patients not response to lithium!
- better than lithium for rapid cycling
- well tolerated-> upward dose titration causes nausea, weight gain, diarrhea, vomiting, hair loss, tremor
Are benzos ever used alone in treating bipolar?
No! Always used with a mood stabilizer - clonazepam is the drug of choice
What drugs are used to control depressive episodes?
lithium, lamotrigine, antipsychotics, antidepressants
Explain the use of lamotrigine in bipolar disorder?
- limited effect in mania
- used for depressive episodes
- alternative to lithium for maintenance (weight neutral)
- mechanism unknown
What is the most common combination of antipsychotics in bipolar disorder?
- olanzapine and fluoxetine
Why are antidepressants dangerous to use as mono therapy in bipolar disorder?
- can switch the person to all mania