Lecture 10 - Bipolar Disorder

Question 1

Drugs used for bipolar disorder?

Answer 1

• lithium
• valproate
• lamotrigine
• atypical antipsychotics
• carbamazepine

Question 2

List the 3 parts to bipolar disorder

Answer 2

• mania
• hypomania
• depression

Question 3

Define mania

Answer 3

• distinct period of dramatically elevated, irritable mood lasting 1 week or more and impairing social functioning
• can include: inflated self-esteem, reduced need to sleep, verbosity, racing thoughts, distractibility, risky behaviour

Question 4

Define hypomania

Answer 4

• briefer duration of manic symptoms
• less severe
• no positive psychotic symptoms

Question 5

Bipolar is divided into:
Bipolar 1
Bipolar 2

Describe them

Answer 5

Bipolar 1:

• episodes of sustained mania, usually with intervening depressive episodes
• more mania

Bipolar 2:

• major depressive episodes with at least 1 manic episode
• more depression

Question 6

___% of adults affected by bipolar in north america

Answer 6

1-3

Question 7

Bipolar 1:

more common in males or females?

Answer 7

equal

Question 8

Bipolar 1:

average onset

Answer 8

at 21

Question 9

Bipolar 2:

more common in males or females?

Answer 9

females

Question 10

Non-pharm treatments for bipolar disorder

Answer 10

adjust sleep, nutrition, exercise, stress, caffeine

Question 11

Pharmacological treatment for bipolar disorder

Answer 11

Mood stabilizers
-lithium, valproate, lomtrigine, carbamazepine
Atypical antipsychotics
Adjunct therapy with benzodiazepines

Question 12

What drugs are used to control manic episodes?

Answer 12

lithium
carbamazepine
valproate
antipsychotics
benzodiazepines

Question 13

How effective is lithium for a manic phase?

Answer 13

60-80%

Question 14

How effective is lithium for maintenance?

Answer 14

60%

Question 15

Patients with mania possessing psychotic features often receive adjunct ??

Answer 15

SGA (olanzapine)

Question 16

How much does lithium reduce suicide?

Answer 16

8-10 fold

Question 17

Does lithium have a fast or slow onset of therapeutic effects?

Answer 17

slow onset

Question 18

What is the major working hypothesis for the mechanism of action for lithium?

Answer 18

Li+ affects the IP3/DAG second messenger system by blocking inositol recycling

Question 19

Early adverse effects of lithium

Answer 19

• GI: nausea, vomitting, diarrhea
• muscle weakness/ lethargy
• polydypsia with polyuria/nocturia (excessive urination or urination at night)
• headache, confusion, tremor
• nephrogenic diabetes insipidus (fluid loss due to abnormal kidney fcn)

Question 20

Long-term adverse effects of lithium

Answer 20

• renal morphology changes
• hypothyroidism and/or goiter
• weight gain > 10 kg
• reduced libido/sexual dysfunction
• edema
• severe acne
• cardiovascular

Question 21

List 3 other adverse effects of lithium

Answer 21

1 - low therapeutic index
2 - problematic in renal inusfficiency
3 - drug interactions

Question 22

Describe the drug interactions with Li+

Answer 22

1 - thiazide diuretics, NSAIDS, ACE inhibitors = increase Li

2 - K+-sparing diuretics = reduce Li

3 - loop diuretics, Ca channel blockers = may increase or decrease Li

Question 23

Carbamazepine is good for?

Answer 23

manic
depression
maintenece

*good for all 3 categories

Question 24

Carbamazepine is better than Li for ??

Answer 24

rapid cycling between the two phases

Question 25

Adverse effects of carbamazepine?

Answer 25

``` nausea vomiting diarrhea hyponatremia rash leukopenia fluid retention drowsiness dizziness lethargy headache ```

Question 26

Valproate is approved for?

Answer 26

anti-manic effects

Question 27

Valproate: | strong efficacy in Patients not responsive to ___

Answer 27

Li

Question 28

Valproate: | better than Li for ??

Answer 28

rapid cycling between the two phases

Question 29

Valproate: | is generally well-tolerated but with upward dose titration - can cause?

Answer 29

``` nausea weight gain diarrhea vomiting hair loss tremour ```

Question 30

Antipsychotics are used alone or with a ??

Answer 30

mood stabilizer

Question 31

Describe benzodiazepines

Answer 31

- used with mood stabilizer - clonazepam is drug of choice - limited by abuse potential beyond acute setting

Question 32

What drugs control depressive episodes?

Answer 32

- lithium - lamotrigine - antipsychotics - antidepressants

Question 33

Lamotrigine has ____ efficacy for mania

Answer 33

limited

Question 34

Lamotrigine has ___ control of depressive episodes

Answer 34

good

Question 35

Lamotrigine is an alternative to lithium for ?

Answer 35

maintenence

Question 36

Combination of antipsychotics is FDA approved for ?

Answer 36

bipolar depression

Question 37

Should you use antidepressants in a bipolar patient?

Answer 37

NO - no quantifiable advantage of mono therapy or combination therapy - monotherapy of antidepressants may precipitate "switch" to mania

Question 38

What drugs are used for maintenance therapy?

Answer 38

``` lithium lamotrigine valproate carbamazepine +psychotherapy ```

Question 39

Lifetime bipolar is diagnosed as ?

Answer 39

3 or more manic episodes or 1 moderate to severe manic episode

Question 40

Drug efficacy is assessed in 3 categories: what are they?

Answer 40

mania depression maintenance

Question 41

_____ is widely used and has efficacy in all 3 categories, but it is associated with therapeutic lag and considerable adverse effects

Answer 41

Lithium

Question 42

Alternatives to lithium for manic episodes

Answer 42

Valproate Carbamazepine SGAs benzodiazepines

Question 43

Alternatives ot lithium for depressive episodes

Answer 43

Lamotrigine | SGAs

Question 44

Alternatives to lithium for maintenance therapy

Answer 44

Valproate Carbamazepine Lamotrigine