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Bipolar Flashcards

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1
Q

What is a manic episode?

A 
A intense high where the person feels euphoric, indestructible and overactive. 
Characterised by: 
- increase self esteem or grandiosity
- decrease need for sleep
- more talkative
- flight of ideas and racing thoughts
- distractibility
- increase in goal directed activity
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2
Q

What is the different between a manic episode and a hypomanic episode?

A

A manic episode has symptoms present most of the day for more than 1 week

Hypomanic has symptoms present most of the day for ≥4 consecutive days, similar to mania but without gross lapses of impulse and judgement and doesnt cause impairment of function

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3
Q

What is rapid cycling?

A

≥ 4 major depressive, manic, hypomanic or mixed episode occurring during a 12 month period

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4
Q

What is the difference between bipolar I and bipolar II disorders?

A

Bipolar I requires ≥ 1 manic episode for diagnosis and ≥MDD

Bipolar II is characterised by recurrent major depressive episodes and hypomanic episodes

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5
Q

What is cyclothymic disorder?

A

≥ 2 years of ‘cycling’ between hypomanic and depressive symptoms (that aren’t MDD)

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6
Q

What is the pathophysiology behind bipolar?

A

May involve:

  • Structural abnormalities: amygdala, hippocampus, basal ganglia and PFC regions
  • Biochemical abnormalities: glutamate, GABA, 5-HT, NA, ACh, DA
  • Genetics
  • HPA system (increase CRF)
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7
Q

What are 4 categories of mood stabilisers?

A
  1. Lithium
  2. Antiepileptics- valproate, carbamazepine
  3. Antipsychotics- atypical, typical
  4. Others- BZD, antidepressants
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8
Q

What are the 3 mechanisms of action of lithium?

A

Li mimics Na in excitable tissue but isn’t pumped out by na/k/ATPase therefore accumulating in cells.

  1. Blocks inositol regeneration by inhibition of inositol monophosphatase (IMPase)
  2. Glycogen synthase kinase-3 inhibition
  3. Neuroprotection- Increase brain derived neurotrophic factor, decrease oxidative stress and glutamatergic transmission
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9
Q

What are some side effects of lithium?

A
  1. Nausea, GI upset
  2. Tremor, muscle weakness
  3. Hormonal effects - thirst and polyuria, hypothyroidism, renal impairment
  4. Cognitive impairment
  5. Acne
  6. Headaches

^ causes non adherence

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10
Q

How does valproate act as a mood stabiliser?

A
  • Decreases glutamate and increases GABA
  • Inhibits GSK-3

Treats manic symptoms and is more effective in rapid cycling than Li and CBZ

Better adherence than lithium as less S/E

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11
Q

When is the use of antipsychotics useful?

A

For the management of mania and as add-on treatments for bipolar depression

Sedative effects may help with mania, and atypicals that increase DA in PFC may aid in depressive symptoms

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12
Q

Why is the use of antidepressants not supported for bipolar?

A

Concerns of over precipitating a drug induced manic episode
Short term use is recommended
SSRIs
Fluoxetine

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13
Q

How is bipolar diagnosed? (4 D’s)

A
  1. Duration of symptoms
  2. Distress to self/others?
  3. Despondent and driven feeling
  4. Evidence of significant dsyfunction
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14
Q

What are the treatment goals?

A
  1. Treat acute exacerbation (control symptoms)
  2. Prevent recurrence
  3. Improve inter-episode functioning
  4. Provide assistance, insight and support to patient and carers
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15
Q

What is the most useful use of lithium?

A

Mania
Prophylaxis of mania and depressive episode recurrence
May decrease suicide risk

Less effective for rapid cycling, mixed mania, schioaffective disorder

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16
Q

When should therapeutic drug monitoring occur for lithium?

A
  1. 5-7 days after initiation
  2. After each dose change
  3. Every 3 months after stable dose is reached
  4. Monitor more during physical illness, medication changes, acute mania/depressive phase
17
Q

What are 5 counselling points for lithium?

A
  1. Re-enforce importance of regular blood tests
  2. Toxicity warning signs (extreme thirst, nausea, vomiting, diarrhoea)
  3. Maintain good diet, with regular salt and fluid intake
  4. Take with food to minimise GI effects
  5. Do not stop taking without discussing with doctor
18
Q

What are 5 counselling points for Sodium valproate?

A
  1. Take with food to reduce GI upset
  2. Can make you feel drowsy
  3. Can increase appetite, watch diet
  4. Tell doctor immediately if fever, rash, abdominal pain, vomiting, jaundice, bruising develop
  5. Dont stop taking
19
Q

When is the use of carbamazepine effective?

A

For acute treatments of manic episodes and mixed states

  • 60% of people who don’t respond to lithium will respond to CBZ
  • Can be used in combination with lithium
20
Q

6 counselling points for carbamazepine?

A
  1. Take with food to reduce GI upset
  2. Can make you feel drowsy
  3. Increase the effect of alcohol
  4. Interacts with many medications- check with pharmacist or Dr
  5. Tell doctor immediately if fever, rash, abdominal pain, vomiting, jaundice, bruising develop
  6. Dont stop taking
21
Q

What is the pharmacists role in bipolar?

A
  • Management: adverse effects, dosage, drug choice, adherence
  • Monitor treatment responses
  • Provide education

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