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Ex3 Flashcards

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1
Q

Bipolar I

A

Disorder where one has at least one episode of mania

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2
Q

Bipolar II

A

Major Depressive and hypomanic esisodes. In contrast to BPI there does not need to be a full blown manic episode

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3
Q

Cyclothymia

A

Less severe form of Bipolar Disorder which has numerous periods of hypmanic symptoms and numerous periods of depressive symptoms

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4
Q

Bipolar, NOS

A

Not otherwise specified means it does not quite fit the checklist

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5
Q

Symptoms of Mania

A

Irritability, Excessive High Risk Activity, Inflated Self-Esteem, Flight of ideas, distractibiliyy,decreased need for sleep

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6
Q

Difference between BP induced depression and MDD

A

The depression associated with BP is one that is briefer in duration, more rapid onset, contain anergia, psychomotor retardation ad reversed vegetative symptoms

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7
Q

Reversed vegetative symptoms

A

Overeating (hyperphagia) and ovversleep (hypersomnia) … this is in contrast to vegetative symptoms which are insomnia and a loss of appetite

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8
Q

Prevelance of BP I and BP II (W/respect to M F)

A

Affects around 1% of population, BDI is equally impactful to males and females while BDII appears to impact females more than males

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9
Q

Age of onset of BP

A

First symptoms around 15-19 while there is a long delay for diagnosis and treatment

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10
Q

Mortality of BP

A

25-50% attempt suicide wherein 19% succeed (high lethality)

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11
Q

Why is differential diagnosis difficukt?

A

Not diagnostic test to say wether or not it is BP. BP depression also can look like MDD< antioscoial behavioral disorder, ADHD, conduct disorder or substance induced disorder

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12
Q

Difference between BP and MDD

A

BP is earlier onset, has more episodes, more familial mania, more equal in sex distribution, HIGHLY heritable,

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13
Q

T/F BP has a high concordance rate among identical twins

A

TRUE

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14
Q

Mood stabilizers

A

Potential pharmacologic use for treatment against BP. Similar in nerobiological action to antidepressants

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15
Q

Structural Changes to brain from MDD

A

Reduction in volume of prefonrtal cortext and hipposcampus, decreases in the number of neurons and glial cells in prefrontal cortext

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16
Q

Chemical Changes to brain from MDD/BD

A

Lower levels of neurochemical N-acetyl-aspartate

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17
Q

N-acetyl-aspartate

A

A neurochemical that is often used as a marker for neuronal health. It shows reduced leves in those with MDD and BD

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18
Q

BDNF

A

Brain derived trophic factor. BDNF is a neurotrophic factor. The use of mood stabilizers is said to reverse impairments toward the level of BDNF in the brain

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19
Q

Neurotrophins

A

Neurotrophins are proteins that induce the survival, development, function and plasticity of neurons

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20
Q

Rita Levi-Montalcini

A

A Nobel Prize winning physiologist that discovered the nerve growth factor (NGF) in the brain which causes develpoing cells to grow by stimulating surronding nerve tissue

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21
Q

Four classes of drugs for the treatment of Bipolar disorder

A

(1) Lithium (2) Anticonvulsant Mood Stabilizers (3) Atypical antipsychotics (4) Omega-3-fatty acids

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22
Q

Why Lithium probably used less than other drugs

A

Lithium, being an element, is not patentable which means companies cannot make a profit from it so there is little incentive to provide it when there are other drugs that are profitable.

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23
Q

Why was Lithium not super effective

A

Compliance is poor, side effects are intolerable and people usually miss the highs and the mood swings. The Lithium serves to really placate and calm the mood swings but some can perceive this as boring

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24
Q

Lithum excretion

A

Lithium is usually excreted unmetabolized. It is less impacted by liver disease as it will just be excreted out and does not need to be broken down by liver enzymes however kidney damage or fluid imbalanence would cause severe problems

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25
Q

What improvement to Lithium treatment could increase compliance

A

More routine blood monitoring and management of symptoms…Though costs and convenience make this hard

26
Q

What can Lithium be perscribed for?

A

Acute mania, BP, Mixed states, depression, schizophrenia, aggressive outburts

27
Q

Clinical effect of Lithium on Mania

A

Decreases the number, frequency and intensity of episodes. The episodes usually shorten in duration. There is a decrease in subtle mood swings between episodes, Takes about 5-10 days for a response. Usually requires a 2nd drug

28
Q

Overdose impact of Lithium

A

There is no specific antidote for intoxication,,, one would likely need dialysis and supportive treatment

29
Q

Side effects of Li

A

There is a NARROW therapeutic range which means regular monitoring is necessary, around 3-5-95% have adverse reactions. Usually some form of cognititve dsyfunction occurs. Other side effects include: reduced renal clearance, organic brain disorder, vomiting, diuretics, low sodium intake and high sodium excreation,

30
Q

Most common side effects of Lithium

A

Hand tremor, incoordination, nystagmus[dancing eyes], muscle weakness, complaints about creativity, lack of excitement

31
Q

“Other” Lithium side effects

A

Renal failure, polyuria, inhibition of vasopression (ADH), dipsogenic, weight gain…Lithium also passes into placenta and breast milk

32
Q

Symptom of severe Lithium toxicity

A

Choreoathetosis, seizures, coma, detth

33
Q

Used of anticonvulsants in mood stabilization

A

Used in bipolar disorder, used to treat relapse to substance abuse, detoxification agent for alcohol withdrawl

34
Q

Problem with use of anticonvulsants

A

They are definitie teratogens and are rarely perscribed to those that are carrying

35
Q

Lamotrigine

A

Lamictal which has improved saftey for mothers with epilepsy and carrying

36
Q

Sources of noncompliance for mood stabilizers

A

Intolerance of side effects, memory impairments, cognitive slowing, weight gain, reduced energy, missing highs and mood swings, feeling the disorder has resolved and that the medication is unnecessary, feeling stigmatized

37
Q

New guidlines for treating manic or mixed episodes

A

The new methodology is to initiate treatment with lithium+antipsychotic or valproate+antipsychotic

38
Q

New guidelines for treating those patients that are less ill for manic/mixed episodes

A

Monotherapy can be utilized with lithium, valporate, or an antipsychotic such as olanzapine

39
Q

New guidelines for depressive episodes

A

First line of treatment for bipolar depression is the initiation of either lihtium or lamotrigine

40
Q

New guidelines for antidepressants

A

Antidepressants should be be administered monotheraputicly

41
Q

New guidelines for treating more severly ill patients

A

Simultaneous treatment with lithium and an antidepressant

42
Q

New guidelines for psychoterpahy

A

New evidence shows strong efficacy of psychoterapy in treatment of unipolar depression but no bipolar depression

43
Q

Manic Flipping

A

A process that is called antidepressant-associated hypomania. It can occur with antidepressant administration to a bipolar depressed patient and cause the patient to switch into a state of mania. Most clinicians do not give ADs without Mood stabilizers….

44
Q

AD most likely to cause Manic Flipping

A

TCA’s more likely over MAOI’s

45
Q

Course of action if manic flipping occurs

A

Taper and discontinue use of AD

46
Q

Negative effects associated with Carbamazepine

A

Sedation, ataxia, visual distrubances, skin reactions, cognitive impairments can cause birth defects …can cause decreased WBC and hypoatemia [electrolyte distrubance where Na levels are low]

47
Q

Metabolic consequence of Carbazepine

A

It induces its own metabolism by autoinduction of cytochrome P450 enzyme. Needs frequent blood monitoring…Has heptic toxicity

48
Q

Difference between carbazepine and oxcarbazepine

A

Oxcarbazepine has an oxygen attached to the heterocycle of the basic unit OXCARBAZEPINE SHOULD BE USED FOR TREATMENT NOT CARBAZEPINE

49
Q

Benefits of Oxcarbazepine

A

It is an inactive prodrug that the live converts to the active species. It does not induce hepatic enzymes. It thus has fewer drug-drug interactions compared to carbamazepine.

50
Q

Side effects of oxcarbazepine

A

tiredness, headache, dizziness, ataxia, allergic reactions, teratogenic effects

51
Q

Benefits of oxcarbazepine over carbazepine

A

No enzyme induction, leukopenia, hepatic toxicities

52
Q

Mechanism of Valproic Acid

A

Valproic Acid inhibits GABA transaminase which breaks down GABA. Can inhibit GABA reuptake and inhibit Na+ action potentials….

53
Q

Valproic Acid used best with

A

Lithium or olanzapine

54
Q

Major side effects of Valproic Acid

A

Teratogenicity (spina bifida) Coma/death in overdose

55
Q

Valproic Acid in comparison to other AED;s

A

Does not induce hepatic microsomal enzymes

56
Q

Treatment for Lamotrigine

A

Treats bipolar disorder, PTSD, schizoaffective disorder ..inhibits glutamate release making it antieplieptic, antimanic and analgesic

57
Q

Side effect of lamotrigine

A

RASH

58
Q

Use of topiramate

A

Effective anticonvulsant and antimanic…causes weightloss

59
Q

Atypical antipsychotics used for mania

A

Colzapine, olanzapine, risperidone, aripiprazole…dopamine blocakde

60
Q

Reasoning for why Omega-3 related to BPD

A

Countries with rich diets in fish oils have a low rate of occurance for BP disorder

psych (4 decks)

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