Bipolar Disorder

Bipolar disorder is described as ___ and periods of ____

1. mania

2. Depression

What is bipolar I disorder?

Periods of major depression, periods of mania, or mixed periods

• Mania: Need to have 3+ symptoms for 1 week (needs to impair function or daily life or result in hospitalization)

• Mixed: Depression with 3+ mania symptoms met for nearly QD for 1 week

What is bipolar II disorder?

Periods of hypomania and major depression

• Hypomania: 3+ mania symptoms for 4 days that result in no impairment of function or hospitalization

What is cyclothymic disorder

Periods of hypomania and depression that doesn’t qualify as major depression

T/F: If bipolar disorder is not diagnosed (pt presents to ER with depression symptoms) and the DR prescribes an antidepressant, the patient can experience mania due to the medication

True,

• Bipolar patients on antidepressants can trigger mania

What is the gold standard of bipolar meds?

Lithium

T/F: Since lithium has a clinical lag, it is not helpful to treat acute manic episodes

True,

• Onset it 7-10 days

• Give antipsychotic or Lorazepam to treat acute manic attacks

What is the MOA of lithium?

inhibits phosphatases to become inositol (recycling of IP3 to PIP2) in a Gq coupled receptor

• How it connects to mood - we don’t really know

Side effects of lithium

• GI

• Tremores and hypothyroidism

• Polyuria and polydipsia

Why do patients on lithium experience polyuria and polydypsia?

Li+ blocks the actions of vasopressin/ADH in the collecting duct/aquaporins in the collecting duct; cannot concentrate the urine

• Large volumes of dilute urine and loses a lot of water, making them thirsty

What can help with polyuria effects from lithium?

A thiazide diuretic or amiloride

• Increases lithium reabsorption from the urine back into the blood

• give a thiazide diuretic which depletes Na⁺. The body will try to conserve Na⁺ by reabsorbing more and since Li⁺ is similar to Na⁺, it reabsorbs enough of the Li⁺ in the proximal and distal tubule so that the concentration of Li⁺ at the collecting duct is too low to impair the actions of vasopressin.