Bipolar D/o Tx, Eating D/os

Front 1

T/F Lithium is effective for an acute manic episode

Back 1

F. It takes awhile to start working. Antipsychotics may be indicated for acute manic episode.

Front 2

Lithium: MOA

Back 2

Poorly understoof.

Front 3

the 4 main drugs used to treat bipolar disorder and mania

Back 3

1) Lithium
2) Divalproate/valproate
3) Carbamazepine
4) Lamotrigine

Front 4

Lithium is particularly effective for what part of bipolar disorder?

Back 4

manic episode - but onset of therapeutic action is slow, consequently, in severe attacks when relief is urgent other therapeutic measures may be needed temporarily.

Front 5

What is the safe use of lithium?

Back 5

must be maintained within a narrow therapeutic range, measured 8-12 hours after administration. Should have serum levels measured once/week.

Front 6

How is Lithium excreted? What are implications of this?

Back 6

renally.

Be sure not to deplete Na because it competes in the kidney for reuptake in urine. It's a diuretic.

Front 7

What level must Li be kept below?

Back 7

1.5 mEq/L

Front 8

What are mild adverse reactions to Li in the therapeutic range?

Back 8

Fine tremor

Nausea

Fatigue

Front 9

What are the moderately severe adverse reactions that can occur at therapeutic levels in susceptible patients?

Back 9

thirst

edema

muscle weakness

polyuria

dermatologic problems

weight gain

Tolerance occurs over time.

Front 10

At levels about 2.0 mEq/L, what is lithium toxicity?

Back 10

diarrhea
vomiting
drowsiness
disorientation
coarse tremor
muscular weakness

Front 11

What is lithium associated with in the kidney?

Back 11

nephrogenic diabetes insipidus

Front 12

What increases toxic effects of lithium?

Back 12

Inadequate fluid intake,

Fluid loss

Sodium depletion

Front 13

What are the peaks of age onset of eating disorders?

Back 13

bimodal: peaks around 14 and 18

Front 14

3 cardinal signs/symptoms of anorexia

Back 14

1) Marked weight loss: failure to maintain body weight above 85% based on age, height, gender

2) Morbid fear of becoming fat

3) Endocrine disorder: amenorrhea for women for at least 3 cycles and loss of sexual potency for men

Front 15

2 subtypes of anorexia

Back 15

1) Restricting - primarily achieve weight loss by self-induced starvation

2) Binge eating/purging type: patient has episodes of binging / purging, also has marked weight loss. Referred to as bulimic anorexics. The bulimic behavior develops later.

Front 16

Which anorexic subtype has the best prognosis? Worst?

Back 16

Best: restricting

Worst: binge eating/purging

Front 17

what personality disorder cluster are the following associated with?

A) restricting anorexic subtype
B) binge eating/purging subtype

Back 17

A) cluster C - avoidant, obsessive compulsive, dept

B) cluster B - narcissistic, borderline, histrionic, antisocial

Front 18

Ego syntonic: defn

Back 18

referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image.

Front 19

Ego dystonic: defn

Back 19

opposite of egosyntonic and refers to thoughts and behaviors (e.g., dreams, impulses, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person's ideal self-image: 'some of the literature uses the term "ego alien"'.

Front 20

What is the overall prognosis of anorexia?

Back 20

In 5-10 years;

1/2 will recover completely

1/4 will be improved

1/4 will be dead (suicide or medical complications)

Front 21

3 cardinal signs/symptoms of bulimia

Back 21

1) Powerful and intractable urges to overeat - binging to reduce unpleasant mood

2) Induced vomiting and abusing purgatives - physical discomfort and fear of gaining weight

3) Morbid fear of becoming fat

Front 22

Two subtypes of bulimia

Back 22

1) purging type : regularly self-induces vomiting or misuses purgatives

2) nonpurging type : fasts or exercises vigorously after binging

Front 23

Anorexia tends to be ego (dystonic, syntonic) while bulimia is ego (dystonic, syntonic)

Back 23

syntonic; dystonic

Front 24

What is the overall prognosis of bulimia?

Back 24

At long term follow up;

1/2 will recover completely

1/4 will be improved

1/4 will be unchanged

Front 25

a deficiency of __________ has been demonstrated in bulimic patients

Back 25

serotonin

Front 26

How does weight loss of depression differ from eating disorders?

Back 26

There is usually a loss of appetite in depression, whreas this doesn't occur in the eating disorders.

In eating disorders, self-esteem is governed by weight. In depression, there is a generalized dimunition in self-esteem.

Front 27

Similaries/differences in psychogenic vomiting from conversion disorder vs bulimic

Back 27

Conversion disorder patients are not secretive - they want secondary gain.

Psychogenic vomiting is usually acute. Eating disorders have a gradual onset.

Front 28

Treatment of anorexia

Back 28

Family therapy.

Hospitalization may be needed for marked weight loss, inability to regain weight with oral intake, or medical complications of anorexia nervosa.

Front 29

Treatment of bulimia

Back 29

Antidepressants, including SSRIs and MAOIs, effective in reducing binging and purging.

Group therapy is particularly useful.

Individual therapy.

Hospitalization may be necessary to break the cycle or for medical complications of bulimia.