Bipolar Disorder

Question 1

What are symptoms of bipolar disorder?

Answer 1

• Episodes of depression
• Hypomania/manc
• Feeling unusually excited, happy, optimistic or felling irritable
• Overactive
• Poor concentration and short attention span
• Poor sleep
• Rapid speech, jump from one idea to another
• Poor judgement (overspending)
• Increased interest in sex
• Psychotic symptoms (hallucination, grandiose, delusion)

Question 2

What are mood stabilisers?

Answer 2

• Lithium
• Sodium valproate
• Carbamazepine
• Lamotrigine
• Antipsychotics

Question 3

What are the theories associated with lithium in bipolar disorder?

Answer 3

• Electrolytes and channels- may compete with magnesium and calcium ions
• Neurotransmitters - Li increases 5HT, chronic Li may reduce 5-HT receptor sites
• Second messenger systems- lithium attenuates the effects of certain neurotransmitters on their receptors without altering receptor density

Question 4

Describes the clinical pharmacology of lithium?

Answer 4

• Renal excretion – advice against with ACE inhibitor
• Slow release preparations can be given once daily
• Lithium levels need to be monitored (at least 3 monthly) and taken 12 hours after last oral dose (narrow therapeutic window)
• Need to check renal function, and thyroid function (can cause hypothyroidism) before starting and every 6 months –

Question 5

What are side effects of lithium?

Answer 5

• Memory problems
• Thirst(hyponatraemia due to thirst being severe)
• Polyuria
• Tremor
• Drowsiness
• Weight gain

Question 6

What are the other effects of lithium of lithium?

Answer 6

• Effect on kidneys
• Endocrine changes- hypothyroidism
• Hair loss
• Rashes

Question 7

What are toxic effects of lithium?

Answer 7

• Need to monitor blood levels closely
• Vomiting
• Diarrhoea
• Coarse tremor
• Dysarthria
• Cognitive impairment
• Restlessness
• Agitation

Question 8

What are treatments of toxicity?

Answer 8

• Supportive measures
• Anticonvulsants
• Increase fluid intake / IV Fluid
• Haemodialysis may be necessary (if toxic dose cant be cleared)

Question 9

Which anti-epileptics are used as mood stabilisers?

Answer 9

• Sodium Valproate
• Lamotrigine
• Carbmezepine