Lecture 6.2 - Bipolar Disorders Flashcards
What are bipolar disorders?
Corresponds to periods of extreme euphoria and depression; including some euthymic periods
What percent of people with bipolar disorder have at least one close relative with the illness?
67% or more than two thirds
70% dual incidence in twin studies
How does a manic episode affect insight and judgement?
It impairs both.
Can a manic episode have psychotic features?
Yes, hallucinations and delusions can occur.
How does a state of mania progress?
It starts with a rapid slow of ideas and euphoria, often increased creativity.
As it progresses an inflated self-worth, incoherent thoughts, disorientation, and risk taking behaviours can increase.
Underlying irritability.
What are the kinds of bipolar disorders?
Bipolar I, II
Cyclothymic disorder
What is bipolar I?
One or more manic episodes with a major depressive occurrence
What is bipolar II
Periods of major depression accompanied by at least one incidence of hypomania
What is hypomania?
Manic behavioural patterns that do not result risk taking behaviours, personal, and professional consequences.
No psychotic features.
What is cyclothymia?
A milder form of bipolar disorder. No overt manic episodes or profound depression, but a cycling of hypomania and depression.
Why might people with bipolar disorders have comorbidities such as substance misuse?
Desire to return to manic state (use of stimulants and amphetamines)?
What kinds of factors contribute to the etiology of bipolar disorders?
Biological:
–> Genetic
–> Neuroendocrine
–> Changes in brain structure
Psychosocial:
–> Mania as a defense mechanism against loss of attachment
What neuroendocrine factors might contribute to bipolar disorders?
Changes in Hypothalamic-pituitary-thyroid-adrenal axis leads to change in NT release (NE, dopamine, serotonin)
What is the clinical course of bipolar disorders? Describe the onset age and trajectory.
Chronic and cyclic disorder that emerges between 21-30 years old.
Sometimes occurs with mild depression and an acute onset of mania, acute psychosis, or several episodes of depression prior to the first manic episode.
The frequency of episodes tends to accelerate over time.
How do bipolar disorders present in children?
Initial presentation is usually depression and associated with intense rage (up to 3 hours).
May be mistaken for ADHD or conduct disorders, difficult to diagnose
How does bipolar disorder affect men and women differently?
Bipolar II is more common in women and they experience more depression, whereas men experience more mania.
What is lithium carbonate used to treat? What is the onset? What is the therapeutic index and when does toxicity occur?
Used to treat bipolar disorder.
Onset: 10-21 days
–> Has narrow therapeutic index (0.6-1.2) and toxicity above 1.5. Monitor blood work.
What are symptoms of lithium toxicity?
N/V/D, thirst, tremors, incoordination, confusion, cardiac arrhythmias, stupor, blurred vision (halos), weakness, blackouts, tremors, seizures.
What kind of patient teaching is necessary for someone taking lithium?
Encourage water and sodium intake to ensure lithium is excreted appropriately by the kidneys and does not damage them.
For this reason, we also monitor kidney and thyroid function at the onset of treatment.
Lithium only starts benefitting people with bipolar disorder 10-21 days after onset of taking it. What can we do for someone who presents with an acute manic episode?
Atypical antipsychotic (often olanzapine) with lithium carbonate.
The antipsychotic has mood stabilizing properties that will help the patient while we wait for lithium to start working. After about 10 days, the antipsychotic will be titrated down.
What kinds of medications are helpful for people with bipolar disorder to decompensate quickly?
Anticonvulsants such as…
Carbamazepine
–> Often combines with antipsychotic and used for people who experience aggression
–> Necessary liver enzyme tests and CBC
Lamotrigine
–> Risk of Stevens-Johnson Syndrome
Valproic Acid
–> Narrow therapeutic range (50-150); signs of toxicity include confusion, fatigue, hallucinations, ataxia. Liver function tests necessary.
–> S/E: Drowsiness, dizziness, increased suicidal ideations.
Which bipolar medication can result in Stephen-Johnson syndrome?
Lamotrigine - anticonvulsant
What bipolar medication is used for patients who are aggressive? What additional assessments are needed for patients on this medication?
Carbamazepine - anticonvulsant
*Liver function tests and CBC necessary
What medication for bipolar has a narrow therapeutic range and increases risk of suicidal ideations and hallucinations?
Valproic Acid / Divalproex Sodium
–> Range of 50-150mcg/ml