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Pathophysiology > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

Bipolar is very hard to diagnose and often resembles the disease: ______

A

Depression

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2
Q

What is bipolar disorder?

A

patients experience episodes of extreme depression and then episodes of mania

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3
Q

What is very very very important with bipolar patients?

A

SLEEP CYCLE

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4
Q

Is the exact cause of bipolar known?

A

No

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5
Q

There has been evidence for imbalance of dysfunction of hormones, neuropeptides and many neurotransmitters. What are the neurotransmitters?

A
  • dopamine
  • NE
  • serotonin
  • melatonin
  • GABA
  • glutamate
  • asparate
  • acetylcholine
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6
Q

What types of medications have been most helpful?

A

meds which decrease neuron excitability

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7
Q

Describe the depressed phase of bipolar disorder

A
  • 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
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8
Q

_________ can switch a patient from a depressive episode into a manic one

A

antidepressants

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9
Q

If the depression side of bipolar disease is so much more severe, it would make sense to give them antidepressants, right?

A

NO! Antidepressants are avoided for many bipolar patients because they can switch a patient from a depressive episode into a manic one

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10
Q

Bipolar depression is very commonly confused with _____ ______

A

unipolar depression

*but these two are very different

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11
Q

Why is there a diagnostic dilemma between bipolar depression and unipolar depression?

A

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.

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12
Q

What kind of medications are involved for bipolar disorder?

A
  • benzodiazepines

- antipsychotics

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13
Q

____ ______ have the best evidence for long-term benefit

A

mood stabilizers

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14
Q

Describe the optimal long term management for BP disorder

A

mood stabilizer plus an antipsychotic along with non-pharm supports including sleep cycle management

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15
Q

What are some warning signs for the manic phase of BP disorder?

A
  • mood changes
  • increased energy/restlessness
  • rapid and pressured speech
  • impulsivity/ impaired judgement
  • distractible
  • irritable
  • psychotic
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16
Q

Describe features of a mixed episode of bipolar disorder (mixed - symptoms of both depression phase and manic phase are present)

A
  • simultaneous symptoms of depression and mania (frantic energy with hopelessness or guilt)
  • anxiety/agitation
  • desperation feeling impulsivity (SUICIDAL)
17
Q

What kind of drugs can trigger a manic episode?

A

Drugs which increase neurotransmitters (5HT, NE, and DA)

  • Glutamate levels are increased
  • hormonal and CRH imbalance significant
18
Q

What can be an effective treatment for a manic episode?

A

Anticonvulsants or calcium channel blockers

19
Q

What is the difference between Bipolar 1 and Bipolar 2?

A

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.
20
Q

Describe signs that would indicate the prognosis of this disease has been improved after or during treatment.

A
  • 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”
21
Q

List some mood stabilizers in bipolar disorder

A
  • lithium
  • anticonvulsants
  • antipsychotics
  • calcium channel blockers ??
22
Q

How does lithium work as a mood stabilizer?

A
  • 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
23
Q

How do anticonvulsants work as a mood stabilizer?

A
  • 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
24
Q

What are examples of some anticonvulsants?

A
  • carbamazepine
  • lamotrigine
  • topiramate
25
Q

Are anticonvulsants generally used as a long-term or short-term treatment for patients with BP disorder?

A

long-term

26
Q

How do antipsychotics help to treat BP disorder?

A

-quite beneficial in treating acute mania

Pathophysiology (15 decks)

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