By Anny Dow, Period 3

Bipolar Disorder

ItIt is a serious brain disorder is a serious brain disorder

An illness characterized by extreme changes in An illness characterized by extreme changes in mood, behavior and energy levelsmood, behavior and energy levels

Also called Manic-Depressive Psychosis (MDP)Also called Manic-Depressive Psychosis (MDP)

This serious mental illness involves mood This serious mental illness involves mood swings that range anywhere from depression to swings that range anywhere from depression to maniamania

Affects nearly 5.7 million Americans!!!

How Bipolar Disorder Affects the Body

How Bipolar Disorder Affects the Body

-it damages to the brain; certain parts

of the brain may be unbalanced in volume

which can affect the brain’s ability to

learn, remember things, and function

-People with BPD tend to suffer from

anxiety and panic, and usually also have

another mental illness

-People with BPD generally die about 7

yrs earlier than that of the average

population, aside from suicide

-Depression forms of BPD have been

linked to be the causes of over-smoking,

drinking, heart disease, heart attacks, high

blood sugar, diabetes, bone loss, stroke,

IBS, even cancer

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When and How do Most Get Bipolar?

When and How do Most Get Bipolar?Most people become bipolar anytime

from their late teens to their early twenties. There are some cases, which are becoming far more frequent lately, that kids get BPD.

Studies show that bipolar children out of control than bipolar adults, often raging for hrs at a time.

There is not a proven cause for BPD yet, but researchers do know that genes can cause a predisposition to the mental illness. Other possibilities include too much stress, overload of excitatory NT glutamate in the synapse.

Some evidence also hints that a lack of vit and/or minerals cause BPD.

These are all possibilities for BPD can range from person to person, so there is no solid cause.

How is a Person’s Daily Life affected?

How is a Person’s Daily Life Affected?

Having BPD is just like having any other disease (diabetes or heart disease). People with BPD suffer from manic and depressive episodes in their daily lives and have to constantly keep watch on their condition.

Victims of the illness are usually extremely tired or overly hyper and are not in control of their brain functions. Their range of moods is abnormal. Without treatment, it worsens quickly. Life is an “emotional roller coaster” for the people with BPD.

Fortunately, BPD comes with many treatment forms. With the proper medication, education, and support, people with BPD can manage and live normal lives.

Symptoms of Bipolar DisorderSymptoms

Depression Form:

- constantly feeling sad or worthless

- sleeping too much or too little

- feeling tired and having little energy

-appetite and weight changes

-problems focusing

- thoughts of suicide

Manic Form:

- increase in energy level

- less need for sleep

- easily distracted

- nonstop talking

- increased self confidence

- focused on getting things done, but does not accomplish much

- is involved in risky activities even though bad things may happen

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What is the Cost of Treatment?What is the Cost of Treatment?

BPD is not cheap to manage. More than a decade ago, the total cost of BPD was estimated to be up to $45 billion a yr. Most of the cost comes from reduced functional capacity and lost work. Compared with the general population, bipolar pts have higher rates of utilization of healthcare resources. The lost productivity of bipolar pts who have committed suicide was $8 billion of the $45 billion in costs recorded in 1991. Only about $7 billion was spent on direct pts care. Misdiagnosis also has to do with increased costs.

Famous People with Bipolar Disorder

Hans Christian Anderson, writer.

Ludwig Van Beethoven, composer.

Lord Byron, poet.

Charles Dickens, author.

Ralph Waldo Emerson, philosopher & poet.

Ernest Hemingway, writer.

Vivien Leigh, actress.

Abraham Lincoln, 16th U.S. president.

Marilyn Monroe, actress.

Isaac Newton, scientist & mathematician.

Florence Nightingale, nurse.

Ozzy Osbourne, singer.

Sylvia Plath, poet.

Edgar Allen Poe, writer.

Axl Rose, musician.

Robert Schumann, composer.

Mark Twain, author.

Vincent Van Gogh, Artist.

Virginia Woolf, poet & novelist.

Frank Bruno, boxer.

Adolf Hitler, dictator.

Winston Churchill, politician.

Francis Scott Key Fitzgerald, writer.

Courtney Love, musician & actress.

Cures/Treatments for Bipolar Disorder

Cures/Treatments for Bipolar DisorderThere is no actual “cure” for BPD yet, but with the

help of various treatments and medications, people with BPD can live normally. These are just a few of the treatments for BPD:

Medications:

Mood Stabilizers- delay and relieve episodes of depression and mania

Antidepressants- work with mood stabilizers to help slow depression

Antipsychotics- helps treat mania and also severe cases of mania/depression

Electroconvulsive therapy (ECT)- used to treat mania/depression

Talk Therapy: Also known as psychotherapy, talk therapy can help people with BPD make sense of their thoughts and feelings. Through talk therapy, people can get valuable advice and support, regain their confidence, and reduce any strain or stress they may have.

Self Care: Learning about BPD is the first critical step in self-care. Tracking and recording moods is also helpful. Avoiding things that may trigger depression/manic episodes and joining a mental illness support group are just a few other things that can help you lessen the stress of having BPD.

 Altman Self-Rating Mania Scale (ASRM)

is a 5-item self-reported  diagnostic scale

which can be used to assess the presence

and severity manic and hypomanic

symptoms, most commonly in patients

diagnosed with BPD

• It assess differences in "normal" or baseline levels in 5 subjective and behavioral areas:

1 positive mood

2 self-confidence

3 sleep patterns

4 speech patterns and amount

5 motor activity

Young Mania Rating Scale•  is an eleven-item, multiple-choice diagnostic questionnaire

which psychiatrists use to measure the severity of manic episodes in pts.

• The scale was originally developed for use in the evaluation of adult pts - BPD, but has since been modified for use in pediatric pts.

• A similar scale was then developed to allow clinicians to interview parents about their children's symptoms, in order to ascertain a better diagnosis of mania in children. Clinical studies have demonstrated the effectiveness of the parent version of the scale.

Mood stabilizers

To prevent both manic and depressive phases of bipolar disorder

1. Lithium

2. Anticonvulsants: Carbamazepine, Valproate, lamotrigine,

3. Risperidone, Olanzapine, ziprasidone, aripiprazole, quetiapine

LithiumLithium• BPD–also along with antidepressants in depression :900-1800 BPD–also along with antidepressants in depression :900-1800

mg/daymg/day• ? Second messenger modification-? Second messenger modification-Phosphatidyl-Inositol-Phosphatidyl-Inositol-

Biphosphate [PIP2]Biphosphate [PIP2] / Membrane stabilization/5HT/regulates / Membrane stabilization/5HT/regulates circadian rhythmscircadian rhythms

• Toxic = Monitor blood levels= (0.8-1.2mEq/L) OW/OMToxic = Monitor blood levels= (0.8-1.2mEq/L) OW/OM• Renal dysfunctionRenal dysfunction polydipsia, polyuria, Cardiac conduction polydipsia, polyuria, Cardiac conduction

abnormalities, GI,abnormalities, GI, tremor, cognitive impairment, tremor, cognitive impairment, Thyroid dysfunctionThyroid dysfunction – hypothyroidism, precipitation of acne – hypothyroidism, precipitation of acne

• BUN, creatinineBUN, creatinine: 3 months: 3 months• WBC,WBC, THYROID, urine output: 3-6 months THYROID, urine output: 3-6 months

C/C/II:-:- PREGNANCYPREGNANCY• COMMON A/E: H, dryness, GI, PPP, hand tremor, COMMON A/E: H, dryness, GI, PPP, hand tremor,

dizziness, fatigue, sedationdizziness, fatigue, sedation• Ataxia, slurring, coarse tremors, confusion, convulsionAtaxia, slurring, coarse tremors, confusion, convulsion

MOA

Lithium - usesLithium - uses

• Prevention of both manic and depressive Prevention of both manic and depressive episodesepisodes

• Aggressive behaviorAggressive behavior

• Borderline personality disorderBorderline personality disorder

• Bulimia nervosaBulimia nervosa

• Cluster headachesCluster headaches

Anorexia nervosa

• Refusal to maintain body

• Wt above a minimal normal

• Very less eating

Bulimia nervosa

• Irresistable craving for food with episodes of over eating in less time

• Attempts to counter act the effects of over eating

1. Self induced vomiting

2. Purgative abuse

3. Appetite suppressants

4. Periods of starvation

Anticonvulsants as mood stabilizers – facilitate GABA- rapid Anticonvulsants as mood stabilizers – facilitate GABA- rapid cycling, mixed episode, alcohol and BZD withdrawalcycling, mixed episode, alcohol and BZD withdrawal

• Intolerance/resistance to LithiumIntolerance/resistance to Lithium

• Carbamazepine -Drug of choice for Trigeminal neuralgia. Carbamazepine -Drug of choice for Trigeminal neuralgia.

A/EA/E:- :- Aplastic, agranulocytosis, sedation, dizziness, Aplastic, agranulocytosis, sedation, dizziness,

ataxia, Steven-Johnson syndrome, ataxia, Steven-Johnson syndrome,

C/C/II:-:- Pregnancy- neural tube defectsPregnancy- neural tube defects

• Oxcarbamazepine: Less blood dyscrasiasOxcarbamazepine: Less blood dyscrasias

• Valproic acid: (psychotic, cognitive, substance abuse)Valproic acid: (psychotic, cognitive, substance abuse)

C/C/II:-:- Pregnancy- neural tube defectsPregnancy- neural tube defects

• VALPROATE, CARBAMAZEPINEVALPROATE, CARBAMAZEPINE

1 Along with lithium to help the action1 Along with lithium to help the action

2 not responding or resistant to lithium2 not responding or resistant to lithium

3 not tolerating lithium3 not tolerating lithium

Remember – Acute phase of mania – antipsychoticLong term treatment – mood stabilizer

ACUTE PHASE OF MANIA: Immediate treatment: ANTIPSYCHOTICS – eg. Haloperidol to acutely control psychotic symptoms and/or diazepam/lorazepamThen LONG TERM treatment with – MOOD STABILIZERS

CARBAMAZEPINE

• 400 – 1000 mg/day

• Most effective for mixed states, rapid cycling

• S/E– sedation, ataxia, aplastic anemia, agranulocytosis

• Check CBC

VALPROATE

• 500 – 2000 mg/day; Highest blood level for effect. Highest dose is 60 mg/kg/day

S/E – GI upset, weight gain, alopecia, teratogenicity, liver problems

• Best for mixed states, rapid cycling, secondary mania. Ineffective for depression

• Selenium for hair loss

ATYPICAL ANTIPSYCHOTICS

• Olanzepine – 2.5-20 mg/day; very effective; significant wt gain and lipid problems in some

• Risperidone - 5-4 mg/day; more EPS and increased prolactin in some

• Clozapine - For truly refractory patient, but can be remarkably effective. Slow response, serious SE profile and significant wt gain

GABAPENTIN

• Anticonvulsant, least effective new drug

• Most helpful with anxiety, insomnia, pain

• May cause persistent sedation

• Excreted by kidneys only, no drug interaction

• 1200 to 4000 mg/day.

LAMOTRIGINE

• Anticonvulsant, best for Bipolar depression

• Improved cognition, excellent tolerance, serious autoimmune rash

• Valproate interaction

• 75 - 300mg/day.

TOPYRAMATE

• Significant cognitive ill effect and paresthesiae

• WEIGHT LOSS

• 50 mg qhs, increase by 50 mg/wk. in divided doses to maximum of 200 mg bid

NEVER GIVE UP

It will help patient to be inspired by us, rather than the other way around

THE END!!!Thank you for your

time.

Hope you enjoyed the presentation!