Bipolar Disorder

Question 1

What is Bipolar disorders MANIC Phase?

Answer 1

• Rapid mood changes - elevated, expansive, irritable, easily “spiked”
• Increased energy/restlessness, decreased need for sleep
• Rapid/pressured speech
• Impaired judgement/impulsivity
• Distractible, flight of ideas
• Psychotic “flavour” is not unusual

Question 2

What is Bipolar disorders DEPRESSED Phase?

Answer 2

• Often more freq. & MORE FEARED - more likely to self report
• antidepressants can switch a person from a depressive into a manic one (avoided for many)

Question 3

Bipolar depression:

Answer 3

• Tx are v. diff from those for unipolar depression
• GENETIC factors are imp
• ***SLEEP-WAKE cycle disruption can elicit the “Expression” of a Manic episode

Question 4

What gene is dysfunctional?

Answer 4

Egr3

1. Reduced ERG3 –> 2. Lower BDNF

Question 5

Neurochemistry of BD?

Answer 5

• imbalance of endogenous factors incl.
  – hormones & NT’s (dopamine, NE, 5HT, Melatonin, GABA, Glutamate, Asparate, AChe)

Question 6

What medications have ben most helpful?

Answer 6

medications with DECREASE NEURON EXCITABILITY

*MOOD STABILIZERS have the best evidence for long-term benefit
- optimal long-term management = a mood stablizier + antipsychotic + sleep cycle management + psychotherapy etc.

Question 7

What are the mood stabilizers in BD?

Answer 7

• Lithium (offsets impact of excessive release/activity of excitatory neurotransmission — 1st choice)
• Anticonvulsants (dampen neurotransmission; leading to increased impulse control & reduced potential for normal fluctuations in mood to become pathologic episodes)
• Antipyschotics (effective in acute mania & in maintenance)

Question 8

What is the adherence in BD?

Answer 8

• longer “stability” increases the resistance to both depressive & manic relapse
• long-term adherence to effective Tx is known to increase QOL & reduce impact
• *adherence & wellness are difficult to achieve with BD