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Flashcards in Ex3 Deck (60):
1

Bipolar I

Disorder where one has at least one episode of mania

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Bipolar II

Major Depressive and hypomanic esisodes. In contrast to BPI there does not need to be a full blown manic episode

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Cyclothymia

Less severe form of Bipolar Disorder which has numerous periods of hypmanic symptoms and numerous periods of depressive symptoms

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Bipolar, NOS

Not otherwise specified means it does not quite fit the checklist

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Symptoms of Mania

Irritability, Excessive High Risk Activity, Inflated Self-Esteem, Flight of ideas, distractibiliyy,decreased need for sleep

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Difference between BP induced depression and MDD

The depression associated with BP is one that is briefer in duration, more rapid onset, contain anergia, psychomotor retardation ad reversed vegetative symptoms

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Reversed vegetative symptoms

Overeating (hyperphagia) and ovversleep (hypersomnia) ... this is in contrast to vegetative symptoms which are insomnia and a loss of appetite

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Prevelance of BP I and BP II (W/respect to M F)

Affects around 1% of population, BDI is equally impactful to males and females while BDII appears to impact females more than males

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Age of onset of BP

First symptoms around 15-19 while there is a long delay for diagnosis and treatment

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Mortality of BP

25-50% attempt suicide wherein 19% succeed (high lethality)

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Why is differential diagnosis difficukt?

Not diagnostic test to say wether or not it is BP. BP depression also can look like MDD< antioscoial behavioral disorder, ADHD, conduct disorder or substance induced disorder

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Difference between BP and MDD

BP is earlier onset, has more episodes, more familial mania, more equal in sex distribution, HIGHLY heritable,

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T/F BP has a high concordance rate among identical twins

TRUE

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Mood stabilizers

Potential pharmacologic use for treatment against BP. Similar in nerobiological action to antidepressants

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Structural Changes to brain from MDD

Reduction in volume of prefonrtal cortext and hipposcampus, decreases in the number of neurons and glial cells in prefrontal cortext

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Chemical Changes to brain from MDD/BD

Lower levels of neurochemical N-acetyl-aspartate

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N-acetyl-aspartate

A neurochemical that is often used as a marker for neuronal health. It shows reduced leves in those with MDD and BD

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BDNF

Brain derived trophic factor. BDNF is a neurotrophic factor. The use of mood stabilizers is said to reverse impairments toward the level of BDNF in the brain

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Neurotrophins

Neurotrophins are proteins that induce the survival, development, function and plasticity of neurons

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Rita Levi-Montalcini

A Nobel Prize winning physiologist that discovered the nerve growth factor (NGF) in the brain which causes develpoing cells to grow by stimulating surronding nerve tissue

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Four classes of drugs for the treatment of Bipolar disorder

(1) Lithium (2) Anticonvulsant Mood Stabilizers (3) Atypical antipsychotics (4) Omega-3-fatty acids

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Why Lithium probably used less than other drugs

Lithium, being an element, is not patentable which means companies cannot make a profit from it so there is little incentive to provide it when there are other drugs that are profitable.

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Why was Lithium not super effective

Compliance is poor, side effects are intolerable and people usually miss the highs and the mood swings. The Lithium serves to really placate and calm the mood swings but some can perceive this as boring

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Lithum excretion

Lithium is usually excreted unmetabolized. It is less impacted by liver disease as it will just be excreted out and does not need to be broken down by liver enzymes however kidney damage or fluid imbalanence would cause severe problems

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What improvement to Lithium treatment could increase compliance

More routine blood monitoring and management of symptoms...Though costs and convenience make this hard

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What can Lithium be perscribed for?

Acute mania, BP, Mixed states, depression, schizophrenia, aggressive outburts

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Clinical effect of Lithium on Mania

Decreases the number, frequency and intensity of episodes. The episodes usually shorten in duration. There is a decrease in subtle mood swings between episodes, Takes about 5-10 days for a response. Usually requires a 2nd drug

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Overdose impact of Lithium

There is no specific antidote for intoxication,,, one would likely need dialysis and supportive treatment

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Side effects of Li

There is a NARROW therapeutic range which means regular monitoring is necessary, around 3-5-95% have adverse reactions. Usually some form of cognititve dsyfunction occurs. Other side effects include: reduced renal clearance, organic brain disorder, vomiting, diuretics, low sodium intake and high sodium excreation,

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Most common side effects of Lithium

Hand tremor, incoordination, nystagmus[dancing eyes], muscle weakness, complaints about creativity, lack of excitement

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"Other" Lithium side effects

Renal failure, polyuria, inhibition of vasopression (ADH), dipsogenic, weight gain...Lithium also passes into placenta and breast milk

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Symptom of severe Lithium toxicity

Choreoathetosis, seizures, coma, detth

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Used of anticonvulsants in mood stabilization

Used in bipolar disorder, used to treat relapse to substance abuse, detoxification agent for alcohol withdrawl

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Problem with use of anticonvulsants

They are definitie teratogens and are rarely perscribed to those that are carrying

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Lamotrigine

Lamictal which has improved saftey for mothers with epilepsy and carrying

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Sources of noncompliance for mood stabilizers

Intolerance of side effects, memory impairments, cognitive slowing, weight gain, reduced energy, missing highs and mood swings, feeling the disorder has resolved and that the medication is unnecessary, feeling stigmatized

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New guidlines for treating manic or mixed episodes

The new methodology is to initiate treatment with lithium+antipsychotic or valproate+antipsychotic

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New guidelines for treating those patients that are less ill for manic/mixed episodes

Monotherapy can be utilized with lithium, valporate, or an antipsychotic such as olanzapine

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New guidelines for depressive episodes

First line of treatment for bipolar depression is the initiation of either lihtium or lamotrigine

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New guidelines for antidepressants

Antidepressants should be be administered monotheraputicly

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New guidelines for treating more severly ill patients

Simultaneous treatment with lithium and an antidepressant

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New guidelines for psychoterpahy

New evidence shows strong efficacy of psychoterapy in treatment of unipolar depression but no bipolar depression

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Manic Flipping

A process that is called antidepressant-associated hypomania. It can occur with antidepressant administration to a bipolar depressed patient and cause the patient to switch into a state of mania. Most clinicians do not give ADs without Mood stabilizers....

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AD most likely to cause Manic Flipping

TCA's more likely over MAOI's

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Course of action if manic flipping occurs

Taper and discontinue use of AD

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Negative effects associated with Carbamazepine

Sedation, ataxia, visual distrubances, skin reactions, cognitive impairments can cause birth defects ...can cause decreased WBC and hypoatemia [electrolyte distrubance where Na levels are low]

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Metabolic consequence of Carbazepine

It induces its own metabolism by autoinduction of cytochrome P450 enzyme. Needs frequent blood monitoring...Has heptic toxicity

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Difference between carbazepine and oxcarbazepine

Oxcarbazepine has an oxygen attached to the heterocycle of the basic unit OXCARBAZEPINE SHOULD BE USED FOR TREATMENT NOT CARBAZEPINE

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Benefits of Oxcarbazepine

It is an inactive prodrug that the live converts to the active species. It does not induce hepatic enzymes. It thus has fewer drug-drug interactions compared to carbamazepine.

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Side effects of oxcarbazepine

tiredness, headache, dizziness, ataxia, allergic reactions, teratogenic effects

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Benefits of oxcarbazepine over carbazepine

No enzyme induction, leukopenia, hepatic toxicities

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Mechanism of Valproic Acid

Valproic Acid inhibits GABA transaminase which breaks down GABA. Can inhibit GABA reuptake and inhibit Na+ action potentials....

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Valproic Acid used best with

Lithium or olanzapine

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Major side effects of Valproic Acid

Teratogenicity (spina bifida) Coma/death in overdose

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Valproic Acid in comparison to other AED;s

Does not induce hepatic microsomal enzymes

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Treatment for Lamotrigine

Treats bipolar disorder, PTSD, schizoaffective disorder ..inhibits glutamate release making it antieplieptic, antimanic and analgesic

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Side effect of lamotrigine

RASH

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Use of topiramate

Effective anticonvulsant and antimanic...causes weightloss

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Atypical antipsychotics used for mania

Colzapine, olanzapine, risperidone, aripiprazole...dopamine blocakde

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Reasoning for why Omega-3 related to BPD

Countries with rich diets in fish oils have a low rate of occurance for BP disorder