Lecture 10: Bipolar Flashcards
What is mania?
Distinct period of dramatically elevated , irritable, mood lasting 1 week or more and impairing social functioning
Symptoms of mania
Can include:
inflated self esteem
Reduced need for sleep
Vrbosity
Racing thoughts
Distractibility
Risky behaviour
What is hypomania?
Briefer duration of manic symptoms
Less severe
Two types of bipolar disorders
Bipolar I: Episodes of sustained mania, usually with intervening depressive episodes
Bipolar II: Major depressive episodes with at least 1 manic episode
Bipolar prevalence
1-3% adults affected in north america
Bipolar I: equal rates in males and females; average onset at 21
Bipolar II: more prevalent in females
Neurochemical theories of bipolar disease
Sensitization and kindling theory
Permissive serotonin hypothesis
Monoamine hypothesis
Cholinergic hypothesis
Bottom line: multiple defects, no solid grasp on mechanism
Non-pharmacological treatments of bipolar
Adjust sleep, nutrition, exercise, stress levels
Pharmacological treatments of bipolar
Mood stabilizers: lithium, valproate, lamotrigine, carbamazepine
Atypical antipsychotics
Adjunct therapy with benzodiazepines
3 phases of control for bipolar
Mania/mixed episodes
Depression episodes
Maintenance
See figure
Drugs used to control manic episodes
Lithium
Carbamazepine
Valproate
Antipsychotics
Benzodiazepines
Control of depressive episodes
Lithium
Lamotrigine
Antipsychotics
Antidepressants
Maintenance therapy
Lithium
Lamotrigne
Valproate
Carbamazepine
+Psychotherapy
Advantage and disadvantage of lithium
Efficacy in all three phases
BUT associated with therapeutic lag and considerable adverse effects
Alternatives to lithium
For manic: valproate, carbamazepine, SGAs, benzodiazepines
For depression: Lamotrigine, SGAs
For maintenance: Valproate, carbamazepine, lamotrigine
