Psych Exam 4: Bipolar and Mood Stabilizers (Sartor)

bipolar type I vs type II

type I has episodes of major depression and mania while II has major depression and hypomania

cyclothymia

episodes of hypomania and mild depression

euthymia

a period of neither mania nor depression

sensorimotor gaiting

the ability to gait (scale) response to a mild vs intense stimulus

genetics of bipolar disorder

no 1 gene

SNPs in voltage-gated calcium/sodium channels seem to increase vulnerability

brain regions affected by bipolar disorder

PFC and limbic abnormalities

vmPFC/vlPFC in bipolar disorder and what do they generally control

hypofunction

controls limbic and endocrine function

vmPFC role

involved in processing emotionally relevant information, which coordinates autonomic and endocrine responses and influences behavior

vlPFC role

involved in regulation of affect

supresses maladaptive emotional responses

6 other factors of neurobiology of bipolar disorder

-intracellular signaling dysnfunction

-ROS

-inflammation

-circadian rhythym dysfunction

-neuroendocrine/autonomic dysfunction

-decreased neuroplasticity

which 3 areas of the brain have increased activity in mania

amygdala

anterior cingulate cortex

basal ganglia

which meds can be used for bipolar

1. mood stabilizers (lithium and anticonvulsants)

2. antipsychotics

receptor MOAs for lihtium

- reduce sensitivity of 5HT-1a receptor (increase 5HT release)

-increase GABAergic activity (reduce mania like working like breaks)

-downregulate NMDA receptors to decrease glutamate neurotransmission

-alters GPCR subunit activity to decrease DA transmission

what is the effect of high levels of glutamate activitt during mania?

it may lead to neurotoxicity 9cell death)

decreased brain volume/cortical matter

cellular signaling MOAs for lithium

-inhibit glycogen synthase kinase -3 (GSK-3) which is active in mania

-increases BDNF to facilitate neuroplasticity

-inhibits IMPase activity that regulates Ca release

Li levels in water

higher lithium levels in water had fewer suicides in texas than those with the lowest amount of sodium

side effects of lithium if toxic doses

-kidney disease

-thyroid disease

-weight gain

-high BP

-delirium, psychosis, seizure, coma

what are atypical antipsychotics often take with for bipolar

with a mood stabilizer

what are the 3 MOAs for atypical antipsychotics in bipolar disorder

-D3/D4 antagonist or D2/3 partial agonist

-5HT2A and 5HT7 antagonist

-5HT1A partial agonist

MOA of valproate

-inhibit GABA transaminase enzyme that breaks down GABA --> causes an increase of GABA

-inhibits Na channels

MOA of carbamazepine

-inhibits Na/Ca channels which reduces Glu release

-enhances GABA receptor activity

-elevate 5HT levels

MOA of lamotrigene

inhibits Na channels

-stabilizes neuronal memebranes, reduces excitability/glutamate release

inhibits Ca channels too