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20 Cards in this Set
- Front
- Back
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Bipolar Disorder |
Person alternates between mania and depression Prevalence =1% lifetime Suicide rate = 30% attempted |
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Bipolar 1 vs 2 |
Bipolar 1 has presence of a complete manic episode Bipolar 2 = presence of ONLY a hypomanic episode, no manic or mixed |
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PFC activity |
Depression = very low activity (even compared to control) mania = very high activity |
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Mood stabilizers for bipolar disorder |
Lithium Anticonvulsant mood stabilizers Atypical antipsychotics Omega-3 fatty acids --limited/mix evidence by itself, good in combination with others |
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Mood stabilizer mechanisms |
-MAYBE interact with intracellular pathways --signaling enzymes (like g-protein coupled receptors) -Especially work on glutamate in hippocampus -different drugs may work on different receptors (or areas). Seem to help produce some common effect (ex =BDNF) |
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FDA approved bipolar meds |
Carbamazepine extended release --> Mania and mixed Lamotrigine --> maintenance Lithium -->Mania and maintenance Valproate -->Mania **ALL CAN be combined with SSRis, anxiolytics, antipsychotics, etc. |
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Lithium |
*GOld standard for bipolar treatemnt -effective for controlling mania and acute depression -effective for ~70% of episodes -1/3 people relapse -instead of EXCITING, it balances out activity |
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Lithium pharmacokinetics |
-No metabolization or liver involvement (because Li+) -Orally administered --peak blood levels after administration (3hrs) --completely absorbed in 8hrs |
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Lithium Pharmacodynamics |
-Has no effects on normal person -Inhibits intracellular enzyme (GSK-3) --> which increased B-catenin protein **B-catenin protein increase = promotes neural survival |
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Lithium side effects (somatic) |
tremor, nausea, shirt weight gain, increased urination, kidney/liver toxicity |
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Lithium side effects (cognitive) |
memory impairment, cognitive slowing, reduced energy/productivity -compliance an issue -person may miss highs of manic |
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Neuromodular anticonvulsants |
Valproic acid Carbamazepine Lamictal |
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Valproic acid |
-less toxic and more effective than lithium -70% response rate in those that are lithium deficient -Stabilizes GABAb receptors in hippocampus -use in combo with lithium |
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Tegretol |
-40% response rate for mania by lithium-resistant -may reduce neural excitability by blocking Na+ channels |
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Valproic acid side effects |
-less side effects (overall) serious side effects = liver damage, pancreatitis, teratogenic (malformed embryo) |
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Tegretol side effects |
-side effects = GI upset, ataxia (loss of body movement control), visual disturbance, skin reaction, cognitive impairments |
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Lamictal |
-Drug of choice for those with bipolar mania and recurrent depression -good for rapid cycling bipolar II *POOR for acute mania |
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Lamictal side effects |
dizziness, tremor , nausea (typical side effects) -skin rash may become major and require hospitalization -may interact with other drugs. Valproate = increased half-life of 50%, Tegretol = cuts half-life of 50% *Can be good for long-term bipolar 1 in adults* |
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STEP-BD study |
Systematic treatment enhancement program -full recovery of 58% of patients after 2 yrs --50% of those eventually relapsed |
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STEP-BD findings |
Antidepressants + mood stabilizers -no more effective than placebo for bipolar treatment -Did NOT help patients with acute depressive and hypomanic symptoms recover faster Lamictal = better for treatment resistant bipolar depression Drugs + psychotherapy = 30-40% relapse reduction in 1-2 yrs |
