Bipolar Disorder and Depression Flashcards
major depressive disorder (mdd) = __________ depression
unipolar
what are some symptoms of mdd/unipolar depression
- chronic depressed mood
- fatigue
- low motivation
- anhedonia
- changes in appetite and sleep
- rumination
- suicidality
- comorbid w anxiety
what is the lifetime prevalence of mdd
approx 15-20%
bipolar disorder = ________ depression
bipolar
what do patients cycle between in bpd
cycles of mania and depression
for the 3 types of bpd, how are they differentiated
depends on the amount of time a person spends in mania and severity of symptoms
what are the differences in the biology of the three types of bpd
trick question! there are not necessarily are differences in biological underpinnings
t/f does a bipolar diagnosis stay w them for their whole life
true
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
type 1
how rapid are the cycling episodes for bpd type 1
rapid daily cycling
what type of bpd is the following: primary symptom presentation is recurrent depression accompanied by hypomanic episodes
type 2 bpd
is the state of mania for bpd type 2 heavy, mild, or light
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
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
cyclothymic disorder
does cyclothymic disorder have more or less severe symptoms than bpd 1 or 2
is has less severe symptoms
describe the characteristics of manic episodes (8)
- distinct period of abnormally and persistently elevated, expansive or irritable mood lasting 1 week
- increased self esteem or grandiosity
- decreased need for sleep (eg feels rested after 3h)
- flight of ideas or subjective experience that thoughts are racing
- more talkative than usual or pressure to keep talking
- distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
- increase in goal directed activity (socially, at work or school, or sexually) or psychomotor agitation (moving a lot and quick)
- 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)
what are the conditions for someone to be diagnosed with the manic side of bpd
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)
describe the characteristics of depressive episodes (9)
- depressed mood most of the day
- diminished interest or pleasure in all or most activities
- significant unintentional weight loss or gain
- insomnia or sleeping too much
- agitation or psychomotor retardation noticed by others
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- diminished ability to think or concentrate, or indecisiveness
- recurrent thoughts of death or suicide
what is the % of genetic component affecting bpd
70-80%
how many genes causes bpd
many, not one single
genetic susceptibility for bpd shares more in common w ____________ than ____________
schizophrenia, unipolar (MDD)
when is the onset of bpd
post-adolescent/early adult (similar to schiz)
% prevalence worldwide
1-2%
what is the difference between the prevalence of bpd in males and females
equal prevalence
what happens to the illness when you don’t have treatment
it gets worse
how can mania be triggered
Mania can be triggered: stressful situation (even good stress), lack of sleep <– upset someone’s equilibrium/daily routine, stimulants, life stress (+/-)
people with bipolar should have a more ___________ lifestyle
regimented
comorbidities of bpd
adhd, anxiety disorder, substance abuse, obesity, and metabolic syndrome (type 2 diabetes, cvd, dyslipidemia)
will the comorbidities still happen even if you take medication
yes
what are the statistics (%) of people w suicidal thoughts, those who attempted, those who completed
80, 50, 15
what are some treatment strategies
mix of mood stabilizers, antipsychotics, and antidepressants, lifestyle changes, psychotherapy
commonly prescribed mood stabilizers
lithium and valproate
what is the best mood stabilizer
lithium salt (lithium carbonate)
what is the mechanism of action of lithium salt
unknown
describe pharmacotherapies
combo of several medicines that depend on the symptoms of the patient (mood stabilizers w antidepressants and antipsychotics)
describe the suspected MOA of lithium salt/lithium carbonate
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 (?)
what are the adverse effects of lithium? (acute (9), chronic (2 key))
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
what is the therapeutic window of lithium and what is the significance of this towards prescribing care
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
what is the anticonvulsant mood stabilizer for bpd
valproic acid (valproate)
t/f anticonvulsants DON’T have some mood stabilizing properties
false
describe the moa of valproate
- 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)
how does the moa of valproate help w bpd
unknown - all we known is that both moa of valproate decrease neuron firing
name two other anticonvulsant mood stabilizers
- lamotrigine (depressive mood stabilizer)
- carbamazepine (manic mood stabilizer)
what are the other applications of lamotrigine
& carbamazepine
epilepsy
what are the targets of lamotrigine
& carbamazepine
blocking glutamate receptors, blocking Ca channels, and others
in total, what are the drugs used to treat bpd
- lithium, valproate
- lamotrigine, carbamazepine
- 2nd gen APS, antidepressants
3 factors that bpd is similar to schizophrenia
onset, prevalence, genetics
how is bpd similar to depression
symptoms
what nt is associated with mania
dopamine
t/f can antidepressants be used (in combo w _________) as a pharmacotherapy for bpd
true, in combo with a mood stabilizer or antipsychotic
what is a 2nd generation antipsychotic medications
Quetiapine
why might 2nd gen antipsychotics be better
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
