Bipolar Disorder - Filtz

Question 1

What are some characteristics of bipolar disorder?

Answer 1

Elevated mood, hyperactivity, insomnia (extreme), verborrhea, extreme risk-taking, hyper sexuality, irritability, gambling, racing thoughts, over-spending, delusions of grandeur
Depression includes apathy, inertia, and self-loathing

Question 2

What are the cycles of bipolar disorder?

Answer 2

Mania
Hypomania
Depression

Question 3

How long does each phase typically last?

Answer 3

Manic phase usually lasts one week
Hypomanic phase can last weeks or months, usually precedes manic phase
Depression can last several months

Question 4

What is it called when the stages in bipolar disorder are gone through quickly?

Answer 4

A rapid cycler

Question 5

What is often the stage that makes it hard for a person to take their meds? AKA they don’t want to lose this stage?

Answer 5

Usually the hypomanic phase. Can get a lot done, fast-thinking, very productive.

Question 6

Men or women affected more?

Answer 6

Equally

Question 7

What is the age of onset?

Answer 7

Usually 18-45, similar to schizophrenia.

Question 8

What is the rate of mortality for bipolar disorder?

Answer 8

High. Usually suicides occur at the end of the depressive phase.

Question 9

Is there a genetic component?

Answer 9

Yes

Question 10

Why are there different drugs for unipolar and bipolar depression?

Answer 10

Because the unipolar antidepressants can provoke a manic phase in a person with bipolar depression. Need a med to decrease mania and help depression.

Question 11

What is the gold standard med for bipolar disorder?

Answer 11

lithium carbonate

Question 12

What is the metabolism of lithium?

Answer 12

It is excreted unchanged in the urine.

Question 13

What is the effectiveness of lithium?

Answer 13

80% effectiveness in manic attacks within 1-2 weeks

Question 14

What is the major problem with lithium?

Answer 14

Toxicity.

Question 15

What happens if a person without bipolar disorder takes lithium?

Answer 15

no effect

Question 16

When do you take lithium? Only in a manic phase?

Answer 16

No, you can take prophylactically.

Question 17

What is the mode of action of lithium?

Answer 17

it is still poorly understood

Question 18

What do we now about the method of action of lithium?

Answer 18

It acts on intracellular enzymes to have a therapeutic effect. This may include phosphotases and GSK-3.

Question 19

What are the adverse effects of lithium?

Answer 19

Lithium substitutes for Mg2+ and Na+, but is less efficient
Adverse effects such as nausea, vomiting, muscle weakness and fatigue. These go away as the body accommodates for the lithium.
Persistent effects include: forgetfulness, mental slowing, hand tremors, polydipsia and polyuria
Hyperthyroidism
Toxicity at high doses (ataxia, slurred speech, confusion, hypotension)
Overdose toxicities (seizure, muscle rigidity, cardiac arrhythmia, deep tremor, coma, death)

Question 20

What is the problem with polydipsia and polyuria?

Answer 20

Water intake has to be regulated. They have a shortage of Na+, but if they drink too much water the lithium will go into the water and create toxicity.

Question 21

What type of compromised organ is lithium contraindicated with?

Answer 21

Compromised renal function

Question 22

What types of medications can be used as mood stabilizers besides lithium?

Answer 22

Anti-convulsant mood stabilizers

Question 23

Which anti-convulsant mood stabilizers can be used to treat bipolar disorder?

Answer 23

Valproic acid
divalproex
clonazepam
carbamazepine
oxcarbazepine
topiramate

Question 24

What is the name of the hypothesis that is used for drugs like valproic acid and carbamazepine in treating bipolar disorder?

Answer 24

Inositol-depletion hypothesis. These drugs may block the mho-inositol transporter.

Question 25

Compare anti-convulsants and lithium as mood stabilizers:

Answer 25

Anticonvulsants are not as effective as lithium
Also not as toxic, and have a faster onset
Problems may include weight gain, sleepiness, inability to concentrate, diaphragmatic depression

Question 26

Why is topiramate different from other mood stabilizers?

Answer 26

Fewer problems with weight gain, but may induce rare closed angle glaucoma.

Question 27

Besides lithium and anti-convulsants, what other drugs can be used to treat bipolar disorder?

Answer 27

Antipsychotics (decreased dosing from schizophrenia)
BZD (rapid efficacy, not long-term)
Vitamin B12 (supplementation with OCD)