Week 7: Bipolar Disorder Meds & Antipsychotics

whaat is bipolar disorder

mood swings between extremes (manic vs depressive)

lithium use (Li+)

influence neural excitability, neuroprotective and limits damage seen in bipolar disorder

pharmacokinetics of lithium

orally, not metabolized, whole drug is eliminated through urine, low therapeutic index

what can be caused by not being able to metabolize lithium

toxicity (mild to moderate)- look in notes for details

anti seizure meds for bipolar

helps stabilzie moods and limit manic symptoms

what are 2 examples of anti seizure meds

carbamazepine, valproic acid

antipsychotic meds for bipolar

for anti-mania

how is anti-seizure and anti-psychotic meds used

during mania or in conjunction with lithium in maintenance dose

rehab concerns of lithium

be aware of sedation and mm weakness, watch for toxicity, risk of suicide is greater

what is psychosis

severe forms of mental health

most common psychosis

schizophrenia

neuroletpics

antipsychotic drugs, that treat disorders instead of sedating, does not offer a cure!

what neurotransmitter changes occur in schizophrenia

overactivity of dopamine, more seratonin, defect in the way GABA controls glutamate (more excited), decreased sensitivity to ACH

what do antipsychotics block

dopamine receptors, serotonin

first generation antipsychotics MOA

strong antagonist of dopamine receptors, high affinity of DF receptor in limbic system

aka typical

second generation antipsychotics MOA

weak antagonists at D2 receptors but strong antagonists of serotonin

aka atypical

traditional antipsychotics characteristics (whats bad about them)

more side effects than atypical, increase incidence of movement disorders and motor side effects, less predictable

atypical antipsychotics

better side effect profile, less movement disorders, as effective as antipsychotics

START WITH THESE- less side effects

other uses of antipsychotics

can be used with lithium during acute manic phase of bipolar disorder, control agitation/aggression in alzheimers

pharmacokinetics of antipsychotics

orally, higher dose during episodes, prolonged can used to enzyme induction

extrapyramidal symptoms of antipsychotics

tardive dyskinesia, pseudoparkinsonism, akathisia, dyskinesia, dystonia, neuroleptic malignant syndrome

non motor effects of antipyshoctics

metabolic, sedation, anticholinergic effects

tardive dyskinesia

often irreversible side effect, involuntary movements of mouth, may develop dysphasia (25% chance of getting this side effect)

pseudoparkinsonism

antipsychotics block dopamine in basal ganglia (resting tremor, bradykinesia, rigidity), symptoms occur when dose is changed or withdrawn

what to not treat pseudoparkinsonism with

primary parkinsonian drugs because this exacerbates psycohtic symptoms

akathisia

motor restlessness (cant sit still)

dyskinesia and dystonia

involuntary and uncoordinated movements, benzos can address it

metabolic effects are seen more in those taking

atypical antipsychotics

metabolic effects symptoms

weight gain, DM, increased plasma lipids

what to screen before taking atypical antipsychotics

CV and metabolic disorders

sedation side effects

differs between drugs, no benefit to pt

anticholinergic effects symptoms and why

why: decrease ACH function

sx: blurred vision, dry mouth, constipation, urinary retention, self limiting problems

other side effects of antipsychotics

OH, photosensitivity, abrupt withdrawal leads to nausea/vomitting

rehab concerns if on antipsycotics

benefits balanced with risk, be alert for extrapyramidal symptoms and send to MD, these are often treated in schiz