Bipolar Disorder - Filtz Flashcards
What are some characteristics of bipolar disorder?
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
What are the cycles of bipolar disorder?
Mania
Hypomania
Depression
How long does each phase typically last?
Manic phase usually lasts one week
Hypomanic phase can last weeks or months, usually precedes manic phase
Depression can last several months
What is it called when the stages in bipolar disorder are gone through quickly?
A rapid cycler
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?
Usually the hypomanic phase. Can get a lot done, fast-thinking, very productive.
Men or women affected more?
Equally
What is the age of onset?
Usually 18-45, similar to schizophrenia.
What is the rate of mortality for bipolar disorder?
High. Usually suicides occur at the end of the depressive phase.
Is there a genetic component?
Yes
Why are there different drugs for unipolar and bipolar depression?
Because the unipolar antidepressants can provoke a manic phase in a person with bipolar depression. Need a med to decrease mania and help depression.
What is the gold standard med for bipolar disorder?
lithium carbonate
What is the metabolism of lithium?
It is excreted unchanged in the urine.
What is the effectiveness of lithium?
80% effectiveness in manic attacks within 1-2 weeks
What is the major problem with lithium?
Toxicity.
What happens if a person without bipolar disorder takes lithium?
no effect
When do you take lithium? Only in a manic phase?
No, you can take prophylactically.
What is the mode of action of lithium?
it is still poorly understood
What do we now about the method of action of lithium?
It acts on intracellular enzymes to have a therapeutic effect. This may include phosphotases and GSK-3.
What are the adverse effects of lithium?
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)
What is the problem with polydipsia and polyuria?
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.
What type of compromised organ is lithium contraindicated with?
Compromised renal function
What types of medications can be used as mood stabilizers besides lithium?
Anti-convulsant mood stabilizers
Which anti-convulsant mood stabilizers can be used to treat bipolar disorder?
Valproic acid divalproex clonazepam carbamazepine oxcarbazepine topiramate
What is the name of the hypothesis that is used for drugs like valproic acid and carbamazepine in treating bipolar disorder?
Inositol-depletion hypothesis. These drugs may block the mho-inositol transporter.
Compare anti-convulsants and lithium as mood stabilizers:
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
Why is topiramate different from other mood stabilizers?
Fewer problems with weight gain, but may induce rare closed angle glaucoma.
Besides lithium and anti-convulsants, what other drugs can be used to treat bipolar disorder?
Antipsychotics (decreased dosing from schizophrenia) BZD (rapid efficacy, not long-term) Vitamin B12 (supplementation with OCD)
