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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


What drugs are used as maintenance therapy?

- lithium, lamotrigine, valproate, carbamazepine
- psychotherapy is also used here