Bipolar Disorder

Question 0

Mania state

Answer 0

At least a week long period of elevated/irritable mood. Increased energy and decreased need for sleep.
Pressured speech, thoughts racing. Low attention span. Impaired judgement. Substance abuse. Grandiose.
Behaviour may be aggressive, intolerant or intrusive. Can experience psychosis.

Question 1

What is bipolar disorder

Answer 1

Alteration between manic and depressive episodes.

Question 2

Depressive state

Answer 2

At least 2 weeks, may continue for 6 months.
Persistent feelings of sadness, anxiety, guilt, anger, isolation, loss in interest of activities, shyness, irritability, lack of motivation, self loathing, morbid suicidal thoughts.

Question 3

Types of BP

Answer 3

BP 1: 1 or more manic or mixed episodes. Often also have 1 or more depressive.
BP 2: depressive episodes which are more frequent and intense than manic. At least 1 manic

Question 4

Epidemiology of BP

Answer 4

Onset usually teens
Men and women equally affected
1% lifetime risk of developing 
After 1 episode relapse risk is 10-15% which doubles after 3 episodes.
5-10% Increased risk of suicide

Question 5

Genetic causes

Answer 5

Strongly heritable - 80%
Some studies suggested many chromosomal regions.
Advanced paternal age linked.

Question 6

Physiological causes

Answer 6

Abnormal modulation between ventral prefrontal and limbic regions, especially amygdala likely to lead to poor emotional regulation.

Question 7

Environmental causes

Answer 7

Between a third and half of adults w bp report traumatic/abusive childhoods. Stressful triggers can trigger symptoms, like breakups, death of family member, physical illness, sleep disturbances and everyday problems.

Question 8

Medications for bp

Answer 8

Usually take 3-4 weeks to be effective.
Lithium carbonate - more for manic phase. Most commonly used. But narrow therapeutic window.
Anticonvulsants (valproate, carbamazepine, lamotrigine) less side effects than lithium.
Antipsychotics (aripriprazole, risperidone) - used in severe syptoms

Antidepressants used to treat depressive stage.

Question 9

Semisodium valproate

Answer 9

Compound of sodium valproate and valproic acid 1:1.
Valproic acid causes increase in inhibitory brain neurotransmitter GABA. As weak inhibitor of 2 enzyme systems that inactivate GABA.
Valproic acid also blocks Na+ channels suppressing repetitive firing of neurones. Use-dependant > block cells firing lots of APs. Also block Na+ channels in inactivated state so not available for AP.

Question 10

Valproic acid and folic acid

Answer 10

Vaproic acid known to inhibit folic acid absorbtion, as well as inducing cytochrome p450 drug metabolising enzymes reducing blood folate levels.