Bipolar disorder

Question 1

What is mania?

Answer 1

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

Question 2

What is hypomania?

Answer 2

brief duration of manic sx- less severe

Question 3

What is bipolar disorder divided into?

Answer 3

Bipolar I and Bipolar II

Question 4

What is bipolar I- who does it affect more?

Answer 4

• episodes of sustained mania, usually with intervening depressive episodes
• equal rate of females and males- onset of 21

Question 5

What is bipolar II- who does it affect more?

Answer 5

• major depressive episodes with at least 1 manic episode

- more prevalent in females than males

Question 6

What are the neurochemical theories of bipolar disorder? What is the consensus out of this?

Answer 6

• sensitization and kindling theory
• permissive serotonin hypothesis
• monoamine hypothesis
• cholinergic hypothesis

– bottom line: there are multiple defects and no real solid grasp on the MOA

Question 7

What are some non-pharm treatments of bipolar disorder?

Answer 7

• adjust sleep, nutrition, exercise, stress levels

Question 8

What are the pharmacological treatments ?

Answer 8

• mood stabilizers
• atypical antipsychotics
• adjunct therapy with benzos

Question 9

What drugs are known to control manic episodes?

Answer 9

• lithium, valproate, antipsychotics, benzos

Question 10

How does lithium aid in bipolar disorder?

Answer 10

• 60-80% effective for manic phase
• it has several reported effects
• • reduced serotonin reuptake
• • reduced DA synthesis
• • increased GABAergic activity
• • increased glutamate
• • reduced neuronal calcium uptake
• major hypothesis is that lithium affects the IP3/DAG second messenger system by blocking inositol recycling

Question 11

What are the adverse effects of lithium?

Answer 11

• -> early: GI disturbances, muscle weakness, polydipsia with polyuria, nocturne, headache, confusion, tremor
• -> long term: renal morphology changes, hypothyroidism and loiter, weight gain, reduces libido, sexual dysfunction, edema, severe acne, cardiovascular

Question 12

What are the drug interactions of lithium?

Answer 12

• thiazide diuretics, NSAIDs, ACE inhibitors all increase Li
• potassium sparing diuretics reduce Li
• loop diuretics, Ca channel blockers may increase of decrease lithium

Question 13

How does carbamazepine work in bipolar disorder?

Answer 13

• aids in manic, depression and maintenance
• similar efficacy to Li, better for rapid cycling
• adverse effects:
• – nausea, vomiting, diarrhea, hyponatremia, rash, leukopenia, fluid retention, drowsiness, dizziness, lethargy, headache

Question 14

How does valproate work?

Answer 14

approved for anti-manic effects

• strong efficacy in patients not response to lithium!
• better than lithium for rapid cycling
• well tolerated-> upward dose titration causes nausea, weight gain, diarrhea, vomiting, hair loss, tremor

Question 15

Are benzos ever used alone in treating bipolar?

Answer 15

No! Always used with a mood stabilizer - clonazepam is the drug of choice

Question 16

What drugs are used to control depressive episodes?

Answer 16

lithium, lamotrigine, antipsychotics, antidepressants

Question 17

Explain the use of lamotrigine in bipolar disorder?

Answer 17

• limited effect in mania
• used for depressive episodes
• alternative to lithium for maintenance (weight neutral)
• mechanism unknown

Question 18

What is the most common combination of antipsychotics in bipolar disorder?

Answer 18

• olanzapine and fluoxetine

Question 19

Why are antidepressants dangerous to use as mono therapy in bipolar disorder?

Answer 19

• can switch the person to all mania

Question 20

What drugs are used as maintenance therapy?

Answer 20

• lithium, lamotrigine, valproate, carbamazepine

- psychotherapy is also used here