Bipolar disorder Flashcards Preview

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Flashcards in Bipolar disorder Deck (20)
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1
Q

What is mania?

A
  • 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
2
Q

What is hypomania?

A

brief duration of manic sx- less severe

3
Q

What is bipolar disorder divided into?

A

Bipolar I and Bipolar II

4
Q

What is bipolar I- who does it affect more?

A
  • episodes of sustained mania, usually with intervening depressive episodes
  • equal rate of females and males- onset of 21
5
Q

What is bipolar II- who does it affect more?

A
  • major depressive episodes with at least 1 manic episode

- more prevalent in females than males

6
Q

What are the neurochemical theories of bipolar disorder? What is the consensus out of this?

A
  • 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

7
Q

What are some non-pharm treatments of bipolar disorder?

A
  • adjust sleep, nutrition, exercise, stress levels
8
Q

What are the pharmacological treatments ?

A
  • mood stabilizers
  • atypical antipsychotics
  • adjunct therapy with benzos
9
Q

What drugs are known to control manic episodes?

A
  • lithium, valproate, antipsychotics, benzos
10
Q

How does lithium aid in bipolar disorder?

A
  • 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
11
Q

What are the adverse effects of lithium?

A
  • -> 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
12
Q

What are the drug interactions of lithium?

A
  • thiazide diuretics, NSAIDs, ACE inhibitors all increase Li
  • potassium sparing diuretics reduce Li
  • loop diuretics, Ca channel blockers may increase of decrease lithium
13
Q

How does carbamazepine work in bipolar disorder?

A
  • 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
14
Q

How does valproate work?

A

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
15
Q

Are benzos ever used alone in treating bipolar?

A

No! Always used with a mood stabilizer - clonazepam is the drug of choice

16
Q

What drugs are used to control depressive episodes?

A

lithium, lamotrigine, antipsychotics, antidepressants

17
Q

Explain the use of lamotrigine in bipolar disorder?

A
  • limited effect in mania
  • used for depressive episodes
  • alternative to lithium for maintenance (weight neutral)
  • mechanism unknown
18
Q

What is the most common combination of antipsychotics in bipolar disorder?

A
  • olanzapine and fluoxetine
19
Q

Why are antidepressants dangerous to use as mono therapy in bipolar disorder?

A
  • can switch the person to all mania
20
Q

What drugs are used as maintenance therapy?

A
  • lithium, lamotrigine, valproate, carbamazepine

- psychotherapy is also used here