Bipolar Disorder and Treatment - Belmaker

Question 1

What are the symptoms of a manic episode in bipolar disorder?

Answer 1

Lack of need for sleep

Hightened sex drive

Hyperactive, talkative

Hightened sense of self

Question 2

What are the risk factors for bipolar disorder?

Answer 2

10-15x familial risk of immediate relative

50-80% monozygotic twin concordance

Females>males

Higher in high SES (unlike schizophrenia)

General prevalence about 0.5%, but may see lower prevalence in areas with lower average age of population and higher prevalence in older populations

Question 3

What are the uses and side effects of Lithium?

Answer 3

Mood stabilizer to prevent and treat acute mania in bipolar disorder.
80% success rate over 24 months

Safer for pregnancy than other treatents

Narrow therapeutic index:
Increased toxicity with diuretics and low salt diets (increase Li retention)-many develop NDI
Blocks TSH (treat with thyroxin)

In pregnancy can induce Epstein’s Abnormality (seen on ultrasound)

EEG changes may indicate intoxication

Question 4

What are the treatments for biploar disorder?

What are their side effects?

Answer 4

Some patients respond to a combination of medications over one, some don’t respond to any. Monotherapy usually not helpful.

1. Lithium
   NDI, can cause EEG changes
2. Carbamazapine (AED):
   Treats acute mania, prevents depression/mania
   Can cause SIADH (opposite of Li)
   Thrombocytopenia, teratogenic side effects
3. Valproic Acid (AED):
   Hepatotoxic, teratogenic, can cause PCOS, hirsuitism, some kidney toxicity
4. Lamotrigine (AED)
   Better in depressive than manic
5. Electroconvulsive Therapy (ECT)
   For acute mania or depression
   Not preventative
6. Antipsychotics
   Weightgain, increased insulin resistance, increased cholesterol, metabolic toxicity
7. Dopamine blockers
   Parkinsonism