Mood Stabilizers - BP Treatment

Question 1

3.3 General Treatment Modalities

Answer 1

Psychotherapies: Cognitive behavioral therapy
Pharmacotherapies: Mood stabilizers, antidepressants, antipsychotics
Somatic therapies: ECT

Question 2

3 Treatments of Mania

Answer 2

Mood stabilizers like lithium
Antipsychotics
ECT

Question 3

Lithium Use

Answer 3

Significant reduction in mortality and suicides

Question 4

Lithium 3 Side Effects and 2 Major Points

Answer 4

Renal problems: polyuria out the ass
Hypothyroidism
Teratogenic effects of tricuspid valve malformations
Heavily dose dependent so you need to find right dose: very narrow therapeutic window
Do pretreatment workup

Question 5

4 Lithium Mech

Answer 5

Acts through GPCRs
Inhibits inositol 1 phosphatase, affecting inositol triphosphate and decreases firing rate
May alter circadian pacemaker at SCN correcting desynchronization
Augments 5HT function, anti depressive

Question 6

Lithium Timetable

Answer 6

Antimanic: 5 days
Antidepressive: 6-8wks

Question 7

Valproate (what it is and mech)

Answer 7

Anticonvulsant effective for rapid cycling and mixed states, not as effective for BPD
May facilitate GABA release and inhibit its degradation

Question 8

Valproate Side Effects

Answer 8

hepatic failure, teratogenic NTDs

Question 9

Carbamezapine (uses and mech)

Answer 9

Used to treat seizures before, now approved for mania, rapid cycling, and mixed states. Inactivates Na channels to decrease excitability

Question 10

Carbamezapine Side Effects (2)

Answer 10

Leukopenia so need to monitor CBCs. Dermatologic rashes like Stevens Johnsons

Question 11

Stevens Johnsons Syndrome

Answer 11

rash that progresses to sloughing, usually from multiple anti convulsants together

Question 12

Lamotrigine (Lamictal)

Answer 12

Anticonvulsant used to treat pretty much everything for bipolar, but have to titrate it slowly w/ gradually increasing dose so NOT for acute mania phases. Good at putting off next episodes and has fairly benign side effects and good stability

Question 13

2nd Gen Antipsychotics

Answer 13

Things like Risperidone and Olanzapine, all have anti-manic activity w/ less PD side effects, but have metabolic syndrome which really increase appetite and weight

Question 14

General Treatment of Depression in BPD

Answer 14

Mood stabilizers like Li and lamotrigine help, so combo treatment w/ one of these and antidepressant probably pharmacotherapy choice

Question 15

Switch Risk

Answer 15

Appears lowest w/ Wellbutrin and then Paxil, then other shit. Highest w/ TCAs

Question 16

6 Steps of Treatment of Depressive Episode w/ BPD

Answer 16

1. Li or lamotrigine
2. That + antidepressant (wellbutrin, paxil for lowest switch risk)
3. Suicidal, may try ECT
4. Add cognitive behavioral therapy
5. Still no response, try bupropion or paroxetine
6. Alternatives include newer antidepressants like SSRIs