feb 26 bipolar disorder pt 3 & schizophrenia pt 1

Bipolar Disorders Treatment

  • Focus on medication-related treatment options

Medication-Based Treatments

  • Lithium

    • An effective mood stabilizer for bipolar disorder

    • Side effects include tremors, sedation, and potential long-term visual changes

    • Personal anecdote shared about how lithium impacted the speaker's art

  • Anticonvulsants

    • Used as mood stabilizers beyond lithium

    • The use stems from the analogy that bipolar disorder may represent a form of nervous system sensitization, similar to epilepsy

    • Notable medications:

    • Valproate semisodium (Epival)

      • Sedating effects; not well tolerated by the speaker

    • Lamotrigine (Lamictal)

      • Perceived as innocuous by the speaker; reported vision change associated with use

  • Cognitive Effects of Anticonvulsants

    • Sedation and amnestic effects noted with many anticonvulsants

    • Gabapentin

    • Primarily for chronic pain; significant cognitive side effects reported

    • Pregabalin suggested as an alternative with a better cognitive profile

Atypical Antipsychotics as Mood Stabilizers

  • Developed primarily for schizophrenia; also beneficial for bipolar disorder

  • Notable atypical antipsychotics:

    • Quetiapine

    • Olanzapine (sometimes combined with an SSRI, marketed as Symbiax)

    • Aripiprazole

    • The speaker's long-term medication

  • Common Side Effects

    • Metabolic issues such as weight gain and tardive dyskinesia (TD)

    • Tardive dyskinesia characterized by involuntary movements of facial muscles and neck; often mistaken for symptoms of the disorder itself

    • TD is classified as an iatrogenic condition (physician-induced illness)

Ethical and Practical Implications

  • Lack of warning about medication side effects from healthcare providers

  • Importance of family history and patient autonomy when prescribing treatments

Theories of Bipolar Disorder

  • Overview of theories discussing the underlying mechanisms of bipolar disorder

Neuroprogression Theory

  • Explains worsening condition over time due to chronic stress response

    • Chronic stress leads to elevated cortisol levels, which can be neurotoxic

    • High cortisol is tied to brain reorganization and decreased coping mechanisms, worsening mood episodes

    • Important brain structures include the hippocampus

Reward Hypersensitivity Model

  • Proposed by Alloy and colleagues, suggesting individuals predisposed to bipolar disorder may have a hypersensitivity to reward-related cues

    • Two pathways identified:

    • Pathway leading to hypomanic or manic episodes

    • Pathway leading to depressive episodes

  • This model highlights the interaction between environmental cues and the individual's behavioral responses

Bipolar Disorder and Creativity

  • Historical links noted between bipolar disorder and creative output

    • Example of Robert Schumann, a composer whose productivity tracked with mood episodes

  • Recent studies suggesting individuals with bipolar disorder may be more engaged in creative professions than the general population

    • Genetic links between creativity and bipolar disorder discussed

Recovery Perspectives

  • Importance of recognizing the potential for recovery from bipolar disorder, which varies among individuals

  • Distinction made between clinical samples and community samples regarding outcomes and treatment efficacy

Questions and Discussions on Medication and Recovery

  • Open discussion about personal experiences with medication, self-disclosure, and the importance of reliable support systems

  • Stigma surrounding mental health and its impact on treatment adherence and experiences emphasized

Transition to Schizophrenia

  • Introduction to schizophrenia, its definitions, and misconceptions

  • Clarifying the term "schizophrenia" as proposed by Eugen Bleuler

    • Focus on disorganization of thoughts, emotions, and behaviors rather than a 'split mind'

Physiological Considerations and Treatment

  • Overview of symptoms and diagnostic criteria according to DSM-5

    • Need for evidence-based duration of symptoms for diagnosis

    • Distinction made between schizophrenia and substance-induced psychiatric symptoms

Positive and Negative Symptoms

  • Positive Symptoms:

    • Hallucinations, delusions, and disorganized speech as added behaviors

  • Negative Symptoms:

    • Absence or reduction in normal functions like emotional responsiveness (flat affect), motivation (avolition), etc.

  • Cognitive symptoms related to attention and memory also addressed

Conclusion

  • Mention of the upcoming guest speaker to provide more personal insight into living with schizophrenia

  • Encouragement for further exploration of both bipolar disorder and schizophrenia symptoms and treatments in future classes.