Lecture 7: Bipolar Disorder

Question 1

Why is bipolar disorder difficult to diagnose?

Answer 1

Often looks like major depression

Question 2

True or false: mania and depression are opposites

Answer 2

True

Question 3

What other disorders can the symptoms of bipolar disorder also look like?

Answer 3

• Extreme depression
• Mix of depression and psychosis
• Damage resulting from prolonged excess of neurotransmitters

Question 4

What is the neurochemistry of bipolar disorder?

Answer 4

Imbalance/dysfunction of hormones, neuropeptides, and many neurotransmitters

Question 5

What are the hormones that are affected in bipolar disorder?

Answer 5

Dopamine, norepinephrine, serotonin, melatonin, GABA, glutamate, aspartate, acetylcholine

Question 6

What type of medications have been the most helpful against bipolar disorder?

Answer 6

Ones which decrease neuron excitability

Question 7

True or false: depressed episode typically outnumber manic/hypomanic episodes

Answer 7

True

Question 8

True or false: manic episodes are typically of more intense concern than depressed episodes

Answer 8

False, depressed episodes are of more concern

Question 9

With regards to self-reporting, are depressed episodes or manic episodes more common?

Answer 9

Depressed episodes

Question 10

What is similar and different between unipolar depression and bipolar depression?

Answer 10

• Similar appearance

- Different pathophysiology and medication approaches

Question 11

What can antidepressants do to someone with bipolar depression?

Answer 11

Can switch them from a depressed episode into a manic episode

Question 12

What type of medications are involved in acute care of bipolar disorder?

Answer 12

Benzodiazepines and antipsychotics

Question 13

What type of medications are best for long-term treatment of bipolar disorder?

Answer 13

A mood stabilizer and an antipsychotic, with non-pharm supports

Question 14

What are 5 warning signs to a manic phase?

Answer 14

Mood changes (easily “spiked”, irritability); increased energy; rapid, pressured speech; impaired judgment; distractible

Question 15

What are features of a mixed episode?

Answer 15

• Simultaneous symptoms of depression and mania
• Anxiety and agitation
• Suicidal thoughts

Question 16

Describe the genetic component of bipolar disorder

Answer 16

Abnormal myelination in several brain regions

Question 17

What can trigger mania?

Answer 17

• Drugs which increase neurotransmitters
• Increased glutamate levels
• Hormonal and CRH imbalance

Question 18

Describe the categories of bipolar disorder

Answer 18

• Bipolar 1 – at least 1 severe manic episode

- Bipolar 2 – patients who experience less severe manic symptoms

Question 19

How is lithium used as a mood stabilizer?

Answer 19

Through 2 “second-messenger” systems, membrane-mediated responses are slowed or “normalized”

Question 20

What is an advantage and disadvantage to lithium as a mood stabilizer?

Answer 20

• Very effective for bipolar disorder

- Very narrow therapeutic window

Question 21

What does valproic acid do as a mood stabilizer?

Answer 21

Antagonizes glutamate, agonizes GABA, and supports neuroregenerative factors

Question 22

What are anticonvulsants useful for in bipolar disorder?

Answer 22

Acute exacerbations or maintenance therapy

Question 23

What are antipsychotics useful for in bipolar disorder?

Answer 23

Acute mania