IDT - Bipolar Disorder Filtz

Question 1

Characteristics of Bipolar Disorder

Answer 1

Cycles of Manic Phase and Depressive phase

Question 2

What defines Mania?

Answer 2

Elevated mood, hyperactivity, extreme insomnia, hypersexuality, over-spending, delusions of grandeur

Question 3

Manic phase typically lasts how long?

Answer 3

1 week but may be proceeded by weeks or months of hypomanic activity

Question 4

What is the challenge of a rapid cycler?

Answer 4

Difficult to treat and stabilize due to continual shifts in mood

Question 5

What population of adults does BP affect?
Who is affected most?
What is the age of onset?
What is the prognosis?

Answer 5

Affects 1-2% of adult population
Men and Women equally affected
Onset from 18-45yo
Genetic Component
High mortality from suicide

Question 6

How is Bipolar treated differently than Unipolar depression?

Answer 6

Mood stabilizers instead of SSRIs, SNRIs

Question 7

What is the most common and effective bipolar treatment?

Answer 7

Lithium Carbonate

Question 8

What is Lithium Carbonate?
How effective is it?
What is its effect?
How is it dosed?
What to watch out for?

Answer 8

Inorganic Cation (excreted unmetabolized)
Effective in 80% of manic attacks within 1-2wks
Major toxic effects
No effect in normal subjects
Used prophylactically
Still misunderstood

Question 9

What Cellular Effects does Lithium most likely interact with?

Answer 9

IMPase/IPPase

GSK-3

Question 10

Adverse effects of Lithium that decrease over time

Answer 10

Nausea, Vomiting

Muscle Weakness Fatigue

Question 11

Persistent Adverse Effects of Lithium

Answer 11

Forgetfulness, Mental slowing
Hand tremors
Polydipsia/Polyuria

Question 12

Effects of Lithium Substiution for Na and Mg

Answer 12

Less efficient, accumulates in excitable cells and disrupts action potentials
Low Therapeutic Index (~2)

Question 13

Toxic Effects of Lithium

Answer 13

Hypothyroidism
Toxicity at higher doses
 - Ataxia, slurred speech
 - Confusion/Disorientation
 - Hypotension

Question 14

Overdose Toxicities of Lithium

Answer 14

Seizure
Muscle Rigidity
Cardiac Arrythmias
Coma and Death

Question 15

Common Anti-convulsants used as Mood Stabilizers

Answer 15

Valproic Acid, Depakote, Clonazepam, Carbamazepine, Oxcarbazepine
Topiramate

Question 16

What are the pros and cons of using anti-convulsants as mood stabilizers vs Lithium

Answer 16

Not as Effective
Not as Toxic
Faster Onset
Problems with Weight gain,a sleepiness, inability to concentrate, diaphragmatic depression

Question 17

What is the Inositol Hypothesis?

Answer 17

The only thing we know about mood stabilizers, their action against Inositol Monophosphatase (IMPase)

Question 18

What other drug classes can be used for the treatment of Mania

Answer 18

Antipsychotics
Benzodiazepine Sedatives
Vitamin B12