Psychopharmacology Ch 6

Bipolar illness

Disorder of mood regulation characterized by cycling between extreme highs or mania and extreme lows or depression

1%

What is the lifetime prevalence of bipolar disorder for the general population?

18.7 years old

What is the average age of the first onset depressive episode?

24.5 years

What is the average age for the first manic episode?

Yes, especially for monozygotic or dizygotic twins

Is there a genetic predisposition for bipolar disorder?

Bipolar Disorder Type I

Well-defined symptom cluster that may present as manic features, depressive features, or mixed mood states.

Bipolar Disorder Type II

Is similar to type 1, but limited to hypomanic states

Cyclothymia

Considered to be the milder form of the classic disease that is characterized by cycles between hypomania and low-level depression

Rapid Cycling

The occurrence of four or more episodes of mania or depression in a 12-month period

15-20%

What percentage of bipolar individuals during the depressive cycle commit suicide?

A neurotransmitter dysregulation or possibly abnormal permeability of the postsynaptic membrane

What is a potential cause of bipolar disorder?

Brain tumors, CNS trauma, stroke, multiple sclerosis, influenza

What are some examples of diseases that are known to exacerbate mania?

Hallucinations, delusions, cognitive impairments

What are the primary clinical features that define psychotic disorders such as schizophrenia?

First-generation antipsychotics mainly block dopamine D2 receptors, while second-generation antipsychotics block both dopamine D2 and serotonin 5-HT2A receptors

How do first-generation (typical) antipsychotics primarily differ from second-generations (atypical) antipsychotics in receptor targeting?

Lithium effectively treats acute mania and prevents relapse

Why is lithium considered the gold standard mood stabilizer in bipolar disorder treatment?

False

True/false: lithium has a wide therapeutic window, so blood level monitoring is rarely necessary

Valproate is used mainly to treat acute mania and is used as an alternative mood stabilizer

What is the primary role of valproate in bipolar disorder treatment?

Second-generation psychotics

Which medication is typically added when a patient with bipolar disorder is experiencing psychotic symptoms?

Monitoring weight, lipids, and glucose levels

What monitoring is essential when initiating second-generation antipsychotics in bipolar disorder?

Because some mood stabilizers, like lithium have better evidence for bipolar depression

Why is it incorrect to assume all mood stabilizers are equally effective for bipolar depression?

Used to prevent bipolar depression relapse rather than treating acute mania

What is the main clinical use of lamotrigine in bipolar disorder?

Because it can induce manic or mixed episodes by destabilizing mood

Why is monotherapy with antidepressants risky in bipolar disorder without mood stabilizers?

0.6 to 1.2 mEq/L

What is the therapeutic serum lithium range for maintenance treatment of bipolar disorder?

Because carbamazepine can reduce lithium levels and increase neurotoxicity risk

Why should carbamazepine not be combined with lithium without caution?

Lithium can cause hypothyroidism

What is the main reason for monitoring thyroid function in patents on lithium?

Check valproate blood levels and adjust dose to reduce side effects while maintaining efficacy

A patient on valproate develops tremor and sedation. What is the best clinical action?

It would increase risk of relapse and rebound mania

Why is it a mistake to stop lithium abruptly in a patient stabilized on it for bipolar disorder?

Carbamazepine induces its own metabolism, requiring dose adjustment over the first weeks to maintain therapeutic levels

How does carbamazepine’s auto induction affect its dosing in bipolar disorder?

Carbamazepine requires monitoring due to risk of hepatotoxicity and blood dyscrasias

Which mood stabilizers requires monitoring of liver enzymes and platelet counts due to potential side effects?

False

True/false: Antidepressants are first-line treatments for bipolar depression without mood stabilizers