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PSY8 Bipolar disorder

Deleted user 11 questions Updated 14 Oct 2019

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  1. 1Bipolar epidemiology
    • Lifetime prevalence of bipolar disorder is ~4.5%
    • 1% of patients meeting criteria for [blank_start]bipolar I[blank_end], 1.1% for [blank_start]bipolar II[blank_end], and 2.4% of patients with [blank_start]subthreshold bipolar disorder[blank_end] (i.e., cyclothymia, unspecified bipolar disorder)
    • Symptom onset for depression, mania, or hypomania in bipolar disorder typically occurs in [blank_start]late adolescence or early adulthood[blank_end], with >⅔ of those affected developing symptoms before [blank_start]18[blank_end] years
    • Depression and mixed presentations may occur more frequently in [blank_start]women[blank_end]
    • Neuroimaging indicates that several anatomic regions (primarily the [blank_start]amygdala[blank_end] within the limbic system and the [blank_start]prefrontal[blank_end] cortex) may contribute to functional abnormalities in bipolar patients
    • Research suggests that altered [blank_start]synaptic and circuit[blank_end] functioning accounts for mood and cognitive changes seen in bipolar disorder, rather than dysfunction of individual neurotransmitters
    • Fluctuating severity of episodes mean its up to an average of [blank_start]8[blank_end] years before mood stabilisers are used
    1. Abipolar I
    2. Bbipolar II
    3. Csubthreshold bipolar disorder
    4. Dlate adolescence or early adulthood
    5. E18
    6. Fwomen
    7. Gamygdala
    8. Hprefrontal
    9. Isynaptic and circuit
    10. J8
  2. 24 types of mood episodes:
    1. Manic episode - abnormally elevated [blank_start]arousal, affect, and energy[blank_end] level. Inflated [blank_start]self-esteem[blank_end], racing [blank_start]thoughts[blank_end], talking [blank_start]quickly[blank_end], [blank_start]sleep[blank_end] difficulty, engages in [blank_start]risky[blank_end] behaviors. A manic episode is differed from hypomania by [blank_start]hospital admission[blank_end].
    2. Major depressive episode - low [blank_start]mood[blank_end], anhedonia, apathy, etc.
    3. Hypomania - elevated or [blank_start]irritated[blank_end] mood, usually a [blank_start]shorter[blank_end] duration than mania.
    4. Mixed - meets criteria for [blank_start]both[blank_end] manic and depressive episode

    Sub-syndromal manic or depressive episodes might also occur which might not meet diagnostic criteria for one of these episodes.
    1. Aarousal, affect, and energy
    2. Bself-esteem
    3. Cthoughts
    4. Dquickly
    5. Esleep
    6. Frisky
    7. Ghospital admission
    8. Hmood
    9. Iirritated
    10. Jshorter
    11. Kboth
  3. 3• Bipolar Type I - occurrence of at least one [blank_start]manic or mixed[blank_end] (full mania and full depression simultaneously) episode. Typically experience major depressive episodes as well.
    • Bipolar Type II – [blank_start]hypomanic and depressive[blank_end] episodes.
    1. Amanic or mixed
    2. Bhypomanic and depressive
  4. 4Others:

    Cyclothymic disorder - Chronic fluctuations between [blank_start]subsyndromal[blank_end] depressive and hypomanic episodes (2 years for adults and 1 year for children and adolescents)

    Persistent depressive disorder ([blank_start]Dysthymia[blank_end]) - Depressed mood most days for at least [blank_start]2[blank_end] years (1 year in children and adolescents).

    [blank_start]Unspecified[blank_end] bipolar and related disorder - Mood states do not meet [blank_start]full[blank_end] criteria
    1. Asubsyndromal
    2. B2
    3. CDysthymia
    4. DUnspecified
    5. Efull
  5. 5Alcohol and substance abuse is common (up to 50% of bipolar patients) and has a significant impact on the age of onset, course of illness and response to treatment.
    1. ATrue
    2. BFalse
  6. 65 - 15% of Bipolar II patients will develop a manic episode over a 5-year period. If this happens the diagnosis is changed to bipolar I disorder.
    1. ATrue
    2. BFalse
  7. 7Choose the incorrect statement.
    1. AAbout half of bipolar I patients have some degree of functional disability after onset, and ~ 10 - 20% have severely impaired psycho-social and occupational functioning.
    2. BSuicide attempts occur in up to 50% of patients with bipolar disorder
    3. CApproximately 10 - 19% of people with bipolar I disorder commit suicide
    4. DMedication discontinuation occurs in 20 - 60% of patients secondary to multiple factors
    5. ERapid cycling (>4 mood episodes/year) is more common in men and occurs in ~10 - 20% of
      bipolar I and II disorder patients making their prognosis poor
  8. 8Bipolar as a spectrum:
    - Type ½ - ‘Schizobipolar’ disorder: [blank_start]Positive symptoms of psychosis[blank_end] with manic, hypomanic, and depressive episodes
    - Type 1 ½ - [blank_start]prolonged hypomania without depression[blank_end], at risk for bipolar type II
    - Type 2 ½ - [blank_start]cyclothymia[blank_end] with full [blank_start]depressive[blank_end] episode(s)
    - Type III – [blank_start]antidepressant induced hypomania[blank_end]
    - Type III ½ - bipolar type 1 with [blank_start]substance abuse-induced hypomania[blank_end]
    1. APositive symptoms of psychosis
    2. Bprolonged hypomania without depression
    3. Ccyclothymia
    4. Ddepressive
    5. Eantidepressant induced hypomania
    6. Fsubstance abuse-induced hypomania
  9. 9• An ideal “mood stabilizer” would treat both mania and depression whilst preventing episodes of either pole, but there is as yet [blank_start]no[blank_end] evidence to suggest that any [blank_start]single[blank_end] agent can consistently achieve this
    • Different [blank_start]drugs[blank_end]/classes effective for different [blank_start]phases[blank_end] of bipolar disorder
    • Antidepressants either do not work, or may worsen symptoms for some (bipolar [blank_start]1[blank_end]) by de-stabilising mood and inducing mania or hypomania, [blank_start]rapid cycling[blank_end] or mixed states and possibly suicidality
    1. Ano
    2. Bsingle
    3. Cdrugs
    4. Dphases
    5. Erapid cycling
    6. F1
  10. 10Drug Txs:

    1. Lithium
    Narrow therapeutic range and renal toxicity therefore [blank_start]TDM[blank_end] needed, range 0.6 - 0.75 mmol/L. Wide variation in dose required, initially [blank_start]0.4–1.2 g[blank_end] daily od or bd. 80% reduced risk of [blank_start]suicide[blank_end], possibly by decreasing impulsive-aggressive behavior. Possible MoAs: modulates [blank_start]G[blank_end] proteins, affects [blank_start]signal[blank_end] transduction via inhibition of [blank_start]2nd messenger enzymes[blank_end], interferes with [blank_start]downstream[blank_end] signal transduction cascades.

    2. Valproic acid
    Effective for the [blank_start]manic[blank_end] phase of bipolar disorder and may prevent recurrence. Not an established treatment for preventing depression but effective for some. MoA: interferes with voltage-sensitive [blank_start]sodium[blank_end] channels by increasing inhibitory actions of [blank_start]GABA[blank_end] and regulating downstream signal transduction cascades. Also interacts with other ion channels e.g. voltage sensitive [blank_start]calcium[blank_end] channels, and indirectly blocks [blank_start]glutamate[blank_end].

    2. Carbamazepine
    Very good for acute [blank_start]mania[blank_end] and maintenance treatment, but is a potent [blank_start]CYP3A4[blank_end] inducer so generally 2nd/3rd line. MoA: Binds to [blank_start]alpha[blank_end] subunit of voltage-sensitive sodium channels and perhaps has additional effects at calcium and potassium ion channels, to enhance the [blank_start]inhibitory[blank_end] effects GABA.

    3. Lamotrigine
    Useful for bipolar [blank_start]depression[blank_end] but unlicensed - increasingly popular. Similar effects to carbamazepine on sodium channels, blocks the α subunit. Also [blank_start]decreases[blank_end] glutamate release, which is unique. Comparatively [blank_start]well[blank_end] tolerated, excluding the
    propensity to cause [blank_start]rashes[blank_end] – minimize by [blank_start]slow[blank_end] dose increases.

    4. Atypical antipsychotics
    For mania:
    Established for psychotic and nonpsychotic mania. In particular, [blank_start]quetiapine and aripiprazole[blank_end]. Antagonism or partial agonism of [blank_start]D2 hyperactivity[blank_end], and antagonism of [blank_start]5-HT2A[blank_end] receptors indirectly reduces [blank_start]glutamate hyperactivity[blank_end], may be MoA.
    For depression:
    Effects [blank_start]5HT2A, 5HT2C, & 5HT1A[blank_end] receptors - indirectly disinhibits [blank_start]NA and DA neurons[blank_end] theoretically improving mood and cognition. Mood improved by blocking NA and 5-HT reuptake.

    Adjunctive treatment options - [blank_start]benzodiazepines[blank_end] for agitation; topiramate or zonisamide for weight
    loss; and [blank_start]gabapentin or pregabalin[blank_end] for anxiety, sleep, or pain
    1. ATDM
    2. B0.4–1.2 g
    3. Csuicide
    4. DG
    5. Esignal
    6. F2nd messenger enzymes
    7. Gdownstream
    8. Hmanic
    9. Isodium
    10. JGABA
    11. Kcalcium
    12. Lglutamate
    13. Mmania
    14. NCYP3A4
    15. Oalpha
    16. Pinhibitory
    17. Qdepression
    18. Rdecreases
    19. Swell
    20. Tslow
    21. Urashes
    22. Vquetiapine and aripiprazole
    23. WD2 hyperactivity
    24. X5-HT2A
    25. Yglutamate hyperactivity
    26. Z5HT2A, 5HT2C, & 5HT1A
    27. AANA and DA neurons
    28. ABbenzodiazepines
    29. ACgabapentin or pregabalin

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User has deleted their subject information Quiz on PSY8 Bipolar disorder, created by Deleted user on 14/10/2019.
Author
Deleted user
Language
English
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Created on 14 Oct 2019 · updated on 14 Oct 2019
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