Bipolar affective disorder 1.4.1 Flashcards
1
Q
What is bipolar affective disorder?
A
- a type of mood disorder
- mood alternates between 2 completely opposite poles
- mania/hypomania w/wo psychotic features
- depression
- bipolar I disorder
- mania
- bipolar II disorder
- hypomana
2
Q
What are the symptoms of bipolar affective disoder BPAD?
A
- Depression
- Same as major depressive disorder
- Low mood, lack of motivation, poor/excessive sleep, loss of interest in activities etc
- Often more severe and harder to treat than MDD
- Mania
- Little need for sleep
- Excessive spending
- Elevated self esteem
- Increased goal-directed activities (e.g. starting business, enrolling in a course) n More talkative / fast paced conversation
- Increased sexual encounters
- Euthymia
- normal mood
- normal level of functioning
3
Q
What can precipitate BPAD?
A
- Not taking medication
- Drug abuse (marijuana, stimulants)
- Certain medications (antidepressants, steroids) n Medical illness
- Stressful life events
4
Q
How is BPAD diagnosed?
A
- meet criteria for manic episode
- atleast one manic episode
- a distinct period of abnormally elevated, expansive, irritable mood lasting atleast 1 week & present for most of the day
- Slide 12 of intro to BPAD
5
Q
How can BPAD affect functioning human?
A
- Approximately one third of patients with BPAD will attempt suicide
- Estimated ~15% of patients with BPAD will take their own lif
- Patients can live “normal” lives when euthymic n
- Work, study
- no affect on cognition
- However, can have large impact when patient is manic or depressed
- Depressive periods often longer than MDD and harder to treat
- Manic relapses often require hospitalisation
- Person can ruin their reputation whilst manic
6
Q
What drug therapy is used for BPAD?
A
- mood stabilisers
- lithium
- anticonvulsants
- sodium valproate
- lithium carbonate
- lamotrigine
- antipsychotics
- olanzapine, risperidone, quetiapine
- antidepressants
- venlafaxine, fluoxetine, sertraline
7
Q
What non drug therapy is used for BPAD?
A
- education & psychotherapy
- electroconvulsive therapy- ECT
8
Q
What is the role of mood stabiliser in BPAD?
A
- Relieve symptoms during manic and depressive episodes
- Prevent recurrence
- Do not worsen symptoms of mania and depression
- Do not accelerate the rate of cycling
- Lithium (Li) remains the drug of choice for acute mania and prophylaxis
9
Q
What is used in the acute phase of a manic episode?
A
- antipsychotic drugs and BZDs are usually needed to provide symptom relief, reduce self-injury and reduce risk to others
- because lithium’s onset of action is delayed for 6-10 days
10
Q
What is the MOA of lithium?
A
- Inhibit synthesis and release of NA, 5HT and dopamine –> enhance the action of reuptake transporters
- Reduce formation of intracellular second messengers - IP3, DAG and cAMP –> decreases neuronal activity
- In BPD there may be an excessive activity in neuronal pathways involved with intracellular second messengers; IP3, DAG and cAMP
11
Q
How does lithium impair sodium action?
A
- Lithium is treated like sodium in body, can alter the distribution of ions critical for neuronal function (Ca2+, Na+, and Mg2+)
- Transport specific ions from one side of the membrane to another
- Ion channel (or gates) open to allow the selective transfer of ions down their concentration gradients
> Na+ and Ca2+ will diffuse into cell making cytosol more positive and causing depolarisation
> K+ will diffuse out making the cytosol more negative and inhibit depolarisation
> Cl- diffuses into cell making cytosol more negative and inhibit depolarisation
12
Q
What is lithium indicated for?
A
- Prevention of manic or depressive episodes in bipolar disorder
- Treatment of acute mania
- Schizoaffective disorder and chronic schizophrenia
13
Q
Lithium:
A) Which patients should we take caution in?
B) Can it be used in pregnancy?
C) Can it be used in lactation?
A
- A- renally impaired patients
- Even relatively mild renal dysfunction requires dose reduction to avoid lithium accumulation and toxicity
- B- no, avoid use esp in 3rd trimester
- C- no, avoid in lactation, lithium enters breastmilk & can accumulate to potentially harmful level
14
Q
Do we need to monitor lithium levels? Why?
A
- yes
- it has a low therapeutic index
15
Q
How do we monitor lithium levels?
A
- Monitor serum lithium concentration (at least 8-12 hours after last dose), once or twice weekly until stabilised, then every 3 months
- Monitor more often during illnesses, changes in diet or temperature, drug treatment
- therapeutic range: 0.5-1.2 mmol/L
- Keep below 1.5 mmol/L
- Initial level: 0.8 – 1.4 mmol/L
- Maintenance level: 0.4 – 1.0 mmol/L
