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PCL200 > Bipolar Disorder and Depression > Flashcards

Bipolar Disorder and Depression Flashcards

1
Q

major depressive disorder (mdd) = __________ depression

A

unipolar

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2
Q

what are some symptoms of mdd/unipolar depression

A
  • chronic depressed mood
  • fatigue
  • low motivation
  • anhedonia
  • changes in appetite and sleep
  • rumination
  • suicidality
  • comorbid w anxiety
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3
Q

what is the lifetime prevalence of mdd

A

approx 15-20%

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4
Q

bipolar disorder = ________ depression

A

bipolar

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5
Q

what do patients cycle between in bpd

A

cycles of mania and depression

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6
Q

for the 3 types of bpd, how are they differentiated

A

depends on the amount of time a person spends in mania and severity of symptoms

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7
Q

what are the differences in the biology of the three types of bpd

A

trick question! there are not necessarily are differences in biological underpinnings

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8
Q

t/f does a bipolar diagnosis stay w them for their whole life

A

true

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9
Q

what type of bpd is the following: the primary symptom presentation is mania (either MORE mania or LESS depressed), or rapid cycling episodes of mania and depression

A

type 1

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10
Q

how rapid are the cycling episodes for bpd type 1

A

rapid daily cycling

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11
Q

what type of bpd is the following: primary symptom presentation is recurrent depression accompanied by hypomanic episodes

A

type 2 bpd

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12
Q

is the state of mania for bpd type 2 heavy, mild, or light

A

it is mild - symptoms aren’t severe enough to cause marked impairment in social or occupational functioning or need for hospitalisation, but sufficient enough to be observed by others

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13
Q

what type of bpd is the following describing: a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bpd

A

cyclothymic disorder

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14
Q

does cyclothymic disorder have more or less severe symptoms than bpd 1 or 2

A

is has less severe symptoms

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15
Q

describe the characteristics of manic episodes (8)

A
  1. distinct period of abnormally and persistently elevated, expansive or irritable mood lasting 1 week
  2. increased self esteem or grandiosity
  3. decreased need for sleep (eg feels rested after 3h)
  4. flight of ideas or subjective experience that thoughts are racing
  5. more talkative than usual or pressure to keep talking
  6. distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
  7. increase in goal directed activity (socially, at work or school, or sexually) or psychomotor agitation (moving a lot and quick)
  8. excessive involvement in pleasurable activities that have a high potential for painful consequences (eg engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
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16
Q

what are the conditions for someone to be diagnosed with the manic side of bpd

A

lasting 1 week of mania - it can be shorter but during diagnosis they usually look for longer or if they needed to hospitalize you (if hospital, any duration)

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17
Q

describe the characteristics of depressive episodes (9)

A
  1. depressed mood most of the day
  2. diminished interest or pleasure in all or most activities
  3. significant unintentional weight loss or gain
  4. insomnia or sleeping too much
  5. agitation or psychomotor retardation noticed by others
  6. fatigue or loss of energy
  7. feelings of worthlessness or excessive guilt
  8. diminished ability to think or concentrate, or indecisiveness
  9. recurrent thoughts of death or suicide
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18
Q

what is the % of genetic component affecting bpd

A

70-80%

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19
Q

how many genes causes bpd

A

many, not one single

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20
Q

genetic susceptibility for bpd shares more in common w ____________ than ____________

A

schizophrenia, unipolar (MDD)

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21
Q

when is the onset of bpd

A

post-adolescent/early adult (similar to schiz)

22
Q

% prevalence worldwide

A

1-2%

23
Q

what is the difference between the prevalence of bpd in males and females

A

equal prevalence

24
Q

what happens to the illness when you don’t have treatment

A

it gets worse

25
Q

how can mania be triggered

A

Mania can be triggered: stressful situation (even good stress), lack of sleep <– upset someone’s equilibrium/daily routine, stimulants, life stress (+/-)

26
Q

people with bipolar should have a more ___________ lifestyle

A

regimented

27
Q

comorbidities of bpd

A

adhd, anxiety disorder, substance abuse, obesity, and metabolic syndrome (type 2 diabetes, cvd, dyslipidemia)

28
Q

will the comorbidities still happen even if you take medication

A

yes

29
Q

what are the statistics (%) of people w suicidal thoughts, those who attempted, those who completed

A

80, 50, 15

30
Q

what are some treatment strategies

A

mix of mood stabilizers, antipsychotics, and antidepressants, lifestyle changes, psychotherapy

31
Q

commonly prescribed mood stabilizers

A

lithium and valproate

32
Q

what is the best mood stabilizer

A

lithium salt (lithium carbonate)

33
Q

what is the mechanism of action of lithium salt

A

unknown

34
Q

describe pharmacotherapies

A

combo of several medicines that depend on the symptoms of the patient (mood stabilizers w antidepressants and antipsychotics)

35
Q

describe the suspected MOA of lithium salt/lithium carbonate

A

appears to block downstream signalling events that occur when dopamine receptors are activated (signalling cascades)

  • lithium acts inside the cell which blocks the activation of signalling cascades (the signalling comes from the postsynaptic dopamine neuron’s receptor sensing the dopamine) which further block dopamine mediated behaviours (?)
36
Q

what are the adverse effects of lithium? (acute (9), chronic (2 key))

A

acute:
* frequent urination (diabetes insipidus)
* headache
* metallic taste
* nausea
* vomiting
* confusion
* shaky hands
* thirsty
* Dry mouth

chronic:
- thyroid problems: insufficient thyroid hormone production
- kidney toxicity: when kidney func is reduced, people must discontinue lithium

37
Q

what is the therapeutic window of lithium and what is the significance of this towards prescribing care

A

Lithium is known to have a narrow therapeutic window, this means that the dose needed to treat the disease is close to the dose that causes toxicity. Blood levels of lithium are monitored to make sure people in the safe range

38
Q

what is the anticonvulsant mood stabilizer for bpd

A

valproic acid (valproate)

39
Q

t/f anticonvulsants DON’T have some mood stabilizing properties

A

false

40
Q

describe the moa of valproate

A
  • blocks voltage gated Na channels - req to propagate action potentials along the axon
  • also changes gene expression and increases the amount of gaba; valproic acid opens up the genes and increases the amount of gene expression at many diff genes (one of these is the enzyme that makes gaba)
41
Q

how does the moa of valproate help w bpd

A

unknown - all we known is that both moa of valproate decrease neuron firing

42
Q

name two other anticonvulsant mood stabilizers

A
  • lamotrigine (depressive mood stabilizer)
  • carbamazepine (manic mood stabilizer)
43
Q

what are the other applications of lamotrigine
& carbamazepine

A

epilepsy

44
Q

what are the targets of lamotrigine
& carbamazepine

A

blocking glutamate receptors, blocking Ca channels, and others

45
Q

in total, what are the drugs used to treat bpd

A
  • lithium, valproate
  • lamotrigine, carbamazepine
  • 2nd gen APS, antidepressants
46
Q

3 factors that bpd is similar to schizophrenia

A

onset, prevalence, genetics

47
Q

how is bpd similar to depression

A

symptoms

48
Q

what nt is associated with mania

A

dopamine

49
Q

t/f can antidepressants be used (in combo w _________) as a pharmacotherapy for bpd

A

true, in combo with a mood stabilizer or antipsychotic

50
Q

what is a 2nd generation antipsychotic medications

A

Quetiapine

51
Q

why might 2nd gen antipsychotics be better

A

you only need to take one drug, quetiapine may be used alone since it seems to have some antidepressant properties for bpd and also be a APS

PCL200 (5 decks)

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