Bipolar Disorder Flashcards
Bipolar is very hard to diagnose and often resembles the disease: ______
Depression
What is bipolar disorder?
patients experience episodes of extreme depression and then episodes of mania
What is very very very important with bipolar patients?
SLEEP CYCLE
Is the exact cause of bipolar known?
No
There has been evidence for imbalance of dysfunction of hormones, neuropeptides and many neurotransmitters. What are the neurotransmitters?
- dopamine
- NE
- serotonin
- melatonin
- GABA
- glutamate
- asparate
- acetylcholine
What types of medications have been most helpful?
meds which decrease neuron excitability
Describe the depressed phase of bipolar disorder
- often depressed episodes outnumber manic episodes
- more intense concern to the individual
- when people are reporting their symptoms themselves, they more commonly talk about depression over manic
- more frequent and more feared than manic episodes
_________ can switch a patient from a depressive episode into a manic one
antidepressants
If the depression side of bipolar disease is so much more severe, it would make sense to give them antidepressants, right?
NO! Antidepressants are avoided for many bipolar patients because they can switch a patient from a depressive episode into a manic one
Bipolar depression is very commonly confused with _____ ______
unipolar depression
*but these two are very different
Why is there a diagnostic dilemma between bipolar depression and unipolar depression?
Many patients will not recognize or devalue hypomanic or manic episodes so they may think they suffer from unipolar depression when in actuality they suffer from bipolar disorder.
What kind of medications are involved for bipolar disorder?
- benzodiazepines
- antipsychotics
____ ______ have the best evidence for long-term benefit
mood stabilizers
Describe the optimal long term management for BP disorder
mood stabilizer plus an antipsychotic along with non-pharm supports including sleep cycle management
What are some warning signs for the manic phase of BP disorder?
- mood changes
- increased energy/restlessness
- rapid and pressured speech
- impulsivity/ impaired judgement
- distractible
- irritable
- psychotic
Describe features of a mixed episode of bipolar disorder (mixed - symptoms of both depression phase and manic phase are present)
- simultaneous symptoms of depression and mania (frantic energy with hopelessness or guilt)
- anxiety/agitation
- desperation feeling impulsivity (SUICIDAL)
What kind of drugs can trigger a manic episode?
Drugs which increase neurotransmitters (5HT, NE, and DA)
- Glutamate levels are increased
- hormonal and CRH imbalance significant
What can be an effective treatment for a manic episode?
Anticonvulsants or calcium channel blockers
What is the difference between Bipolar 1 and Bipolar 2?
Both groups are subject to major depression.
- Bipolar 1 indicates at least one severe manic episode.
- Patients who experience less severe manic symptoms (hypomania) are considered to be Bipolar 2.
Describe signs that would indicate the prognosis of this disease has been improved after or during treatment.
- lack of rapid cycling
- little or no psychotic features, substance abuse, med problems, suicidal thoughts
- decent work history, shorter manic/depressive phases, absence of residual depressive symptoms when “well”
List some mood stabilizers in bipolar disorder
- lithium
- anticonvulsants
- antipsychotics
- calcium channel blockers ??
How does lithium work as a mood stabilizer?
- through two “second-messenger” systems (phosphatidylinositol and cAMP) membrane-mediated responses are slowed or normalized
- offsets the impact of excessive neurotransmitter release/activity
- indirect serotonergic enhancing effects can be really significant
How do anticonvulsants work as a mood stabilizer?
- ex. valproic acid - antagonizes glutamate, is a GABA agonist, supports neurodegenerative factors
- anticonvulsant effectiveness involves the dampening of excessive neurotransmission and NT’s leading to increased control over impulses decreased potential for normal fluctuations in mood to become pathologic episodes
What are examples of some anticonvulsants?
- carbamazepine
- lamotrigine
- topiramate
