Chapter 14: Bipolar Disorders

Chapter 14: Bipolar Disorders

Bipolar Disorder 1

  • Definition: Characterized by at least one manic episode, which may alternate with depressive episodes.

  • Mania: Severe enough to cause marked impairment in social or occupational functioning.

  • Medications:

    • Mood Stabilizers: Lithium

    • Anticonvulsants: Valproic acid, Carbamazepine, Lamotrigine

    • Antipsychotics: Olanzapine, Risperidone

Bipolar Disorder 2

  • Definition: Involves recurrent major depressive episodes with at least one hypomanic episode.

  • Hypomania: Less severe than mania and does not cause significant impairment.

  • Medications:

    • Mood Stabilizers: Lithium

    • Anticonvulsants: Lamotrigine, Valproic acid

    • Antipsychotics (as adjuncts): Olanzapine, Risperidone

Cyclothymic Disorder

  • Definition: A chronic mood disturbance lasting at least 2 years (1 year in children/adolescents), characterized by numerous periods of hypomanic symptoms and depressive symptoms that do not meet full criteria for episodes.

  • Symptoms: Less severe but persistent.

  • Medications:

    • Mood Stabilizers: Lithium

    • Anticonvulsants: Valproic acid, Lamotrigine

Medication Categories for Bipolar Disorders

Mood Stabilizers

  • Lithium:

    • Actions: Alters sodium transport in nerve and muscle cells, stabilizing mood and reducing mania.

    • Side Effects: GI distress, fine hand tremors, polyuria, weight gain, hypothyroidism, renal toxicity, lithium toxicity (narrow therapeutic range).

    • Patient Education:

    • Maintain consistent sodium/fluid intake.

    • Take with food or milk.

    • Regular blood draws for lithium levels.

    • Report signs of toxicity: diarrhea, vomiting, coarse tremors, confusion.

Anticonvulsants

  • Valproic Acid:

    • Actions: Increases GABA levels, stabilizing mood and reducing manic episodes.

    • Side Effects: GI upset, hepatotoxicity, pancreatitis, thrombocytopenia, weight gain.

    • Patient Education:

    • Take with food.

    • Regular liver function tests and platelet counts.

    • Report abdominal pain, jaundice, or unusual bleeding.

  • Carbamazepine:

    • Actions: Slows sodium influx into neurons, reducing mania.

    • Side Effects: Blood dyscrasias (anemia, agranulocytosis, leukopenia), dizziness, vision changes, rash, hyponatremia.

    • Patient Education:

    • Monitor CBC and sodium levels.

    • Report fever, sore throat, or rash.

    • Avoid grapefruit juice (increases toxicity).

  • Lamotrigine:

    • Actions: Inhibits glutamate release, stabilizes mood, especially effective for bipolar depression.

    • Side Effects: Dizziness, double vision, headache, nausea, life-threatening rash (Stevens–Johnson syndrome).

    • Patient Education:

    • Report rash immediately.

    • Titrate dose slowly to reduce rash risk.

    • Use caution with activities requiring alertness.

Antipsychotics

  • Olanzapine:

    • Actions: Blocks dopamine and serotonin receptors, controlling acute mania and agitation.

    • Side Effects: Sedation, weight gain, metabolic syndrome, orthostatic hypotension, anticholinergic effects.

    • Patient Education:

    • Rise slowly to avoid dizziness.

    • Monitor weight, glucose, and lipid levels.

    • Report excessive sleepiness or unusual movements.

  • Risperidone:

    • Actions: Blocks dopamine and serotonin receptors, stabilizing mood and treating psychotic features.

    • Side Effects: Extrapyramidal symptoms (EPS), weight gain, increased prolactin (galactorrhea, gynecomastia), orthostatic hypotension, muscle rigidity.

    • Patient Education:

    • Avoid alcohol and CNS depressants.

    • Monitor weight and labs regularly.

    • Take at night to reduce side effects.