Pharmacotherapy for Bipolar Disorder
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Questions and Answers

What is a major concern regarding the use of lithium as a mood stabilizer?

  • Immediate response in all users
  • High efficacy in all patients
  • Narrow therapeutic window requiring regular blood tests (correct)
  • Lack of side effects

    • What percentage of people may not respond to lithium treatment for bipolar disorder?

  • 60%
  • 30%
  • 40% (correct)
  • 50%

    • What is a common side effect associated with atypical antipsychotics?

  • Rapid heartbeat
  • Tardive dyskinesia (correct)
  • Severe anxiety
  • Increased appetite

    • How do anticonvulsants typically stabilize mood according to current understanding?

    <p>By affecting calcium and sodium channels</p> Signup and view all the answers

    What action does lithium possibly take on the GSK-3B protein?

    <p>Deactivates it to help reset the body’s clock</p> Signup and view all the answers

    Why are antidepressants generally prescribed less frequently for bipolar disorder?

    <p>They can induce manic episodes</p> Signup and view all the answers

    What is a potential impact of excessive coffee intake while on lithium?

    <p>Decreased lithium absorption</p> Signup and view all the answers

    Which of the following is a potential effect of long-term lithium use?

    <p>Kidney and thyroid effects</p> Signup and view all the answers

    What is a significant goal of Cognitive Behavioral Therapy (CBT)?

    <p>To examine how thoughts contribute to emotional reactions</p> Signup and view all the answers

    Which characteristic is associated with sleep patterns in Major Depressive Disorder (MDD)?

    <p>Earlier onset of first REM stages</p> Signup and view all the answers

    What differentiates Mindfulness-Based Cognitive Therapy (MBCT) from traditional therapy?

    <p>Use of non-evaluative awareness of the present</p> Signup and view all the answers

    Which of the following is not a focus area in Interpersonal Psychotherapy (IPT)?

    <p>Cognitive distortions</p> Signup and view all the answers

    Which statement regarding the hippocampus in relation to depression is true?

    <p>Child abuse can lead to cell death in the hippocampus.</p> Signup and view all the answers

    How is Behavioral Activation utilized in CBT?

    <p>To increase engagement in rewarding activities</p> Signup and view all the answers

    Which medication type primarily targets serotonin reuptake?

    <p>SSRIs</p> Signup and view all the answers

    What does the increased activity in the amygdala during depression typically indicate?

    <p>Increased attentional biases.</p> Signup and view all the answers

    Which of the following is a common side effect of SSRIs?

    <p>Nausea</p> Signup and view all the answers

    What is an observed effect of sleep deprivation on individuals with bipolar disorder?

    <p>Induction of mania symptoms</p> Signup and view all the answers

    What is a primary focus of Cognitive Behavioral Therapy (CBT) in treating mood disorders?

    <p>Changing negative thought patterns</p> Signup and view all the answers

    Which therapy specifically integrates mindfulness practices into cognitive therapy?

    <p>Mindfulness-Based Cognitive Therapy</p> Signup and view all the answers

    What factor does Interpersonal Psychotherapy (IPT) primarily address in individuals with Major Depressive Disorder?

    <p>Social and interpersonal role difficulties</p> Signup and view all the answers

    What effect do sleep patterns have on individuals with depression?

    <p>They often exacerbate symptoms of depression</p> Signup and view all the answers

    How can damage to the hippocampus affect mood disorders?

    <p>It may impair memory and emotional regulation</p> Signup and view all the answers

    Which symptom would indicate a significant weight change in assessing Major Depressive Disorder?

    <p>Gaining 6% of body weight in one month</p> Signup and view all the answers

    Which statement accurately describes the relationship between depression and anxiety disorders?

    <p>Anxiety disorders can worsen depression's course</p> Signup and view all the answers

    What is the average duration of a Major Depressive episode?

    <p>6-9 months</p> Signup and view all the answers

    Study Notes

    Pharmacotherapy for Bipolar Disorder

    • About 50% of people respond to antidepressants after completing a medication trial.

    • Lithium is a mood stabilizer used for many years.

      • Its mechanism of action is not fully understood.
      • It may deactivate the GSK-3B protein, which is involved in the circadian clock.
      • It may also decrease glutamate levels.

    • Lithium has a narrow therapeutic window, requiring regular blood draws due to potential toxicity.

      • It can also affect the kidneys and thyroid, and cause dehydration, weight gain, hair thinning, and hand tremors.
      • Coffee and salt intake should be monitored carefully.

    • Around 40% of individuals do not respond to lithium.

      • Its effectiveness can decrease over time in approximately 70% of patients.

    • Anticonvulsants are commonly used as second-line treatment for bipolar disorder.

      • Examples include Carbamazepine, valproate, lamotrigine, gabapentin, topiramate, oxcarbazepine.
      • The exact mechanism of mood stabilization remains unclear.
        • Many anticonvulsants increase GABA and decrease glutamate levels.
        • Some may act on calcium or sodium channels, which regulate action potentials.

    Atypical Antipsychotics

    • Atypical antipsychotics are newer drugs that offer mood-stabilizing effects.

      • They are particularly beneficial for managing psychotic symptoms.
      • They act on dopamine and serotonin systems.
      • Common examples include Aripiprazole, Clozapine, Ziprasidone, Risperidone, Quetiapine, and Olanzapine.

    • Atypical antipsychotics can occasionally cause tardive dyskinesia.

    • Antidepressants are rarely prescribed for bipolar disorder due to the risk of triggering manic episodes.

    Sleep Neurophysiology

    • Major depressive disorder (MDD) is associated with a decrease in slow-wave sleep and an earlier onset of rapid eye movement (REM) sleep.

      • REM sleep in MDD is characterized by higher frequency and amplitude of eye movements.

    • Sleep deprivation can induce manic symptoms.

      • This suggests a link between bipolar disorder and sleep dysregulation.

    Neuroimaging

    • Depression is linked to reduced blood flow and glucose metabolism in the prefrontal cortex.

      • This pattern is reversed (increased activity) in mania.

    • Individuals with depression show increased glucose metabolism in the subgenual anterior cingulate cortex, potentially related to attentional biases.

    • Increased activity in the amygdala is observed in depression.

    Cognitive Behavioral Therapy (CBT) for Depression

    • The goal of CBT is to increase awareness of thoughts and appraisals of events, and to examine how these cognitions contribute to emotional responses.

    • CBT typically involves 16-20 sessions.

      • It utilizes Socratic questioning and guided discovery.
      • Activity monitoring and scheduling are implemented, promoting "behavioral activation" to counteract Lewinsohn's theory.

    • Distorted thinking is challenged through thought records and behavioral experiments.

    • Some evidence suggests that CBT is more effective than psychodynamic psychotherapy and comparable to antidepressants and Interpersonal Psychotherapy (IPT).

      • It has been shown to reduce relapse rates in the long term.
      • Behavioral activation is considered a crucial component.

    Mindfulness-Based Cognitive Therapy (MBCT) for MDD

    • MBCT utilizes Buddhist principles to cultivate non-judgmental awareness of the present moment.

      • It aims to detach from ruminative thinking and foster a decentered perspective towards depression-related thoughts and feelings.

    • Studies have shown that MBCT reduces relapse rates in individuals with depression, compared to treatment as usual (TAU).

    Interpersonal Psychotherapy (IPT)

    • IPT is rooted in psychodynamic theories, framing loss and disordered attachment as contributing factors to depression.

    • It emphasizes the role of interpersonal context in the development of depression.

    • IPT typically involves 12-16 sessions, focusing on resolving interpersonal conflicts in areas such as:

      • Interpersonal disputes (e.g., marital, family relationships)
      • Role transitions (e.g., life changes)
      • Grief and loss
      • Interpersonal deficits (e.g., improving or developing relationships)

    • IPT has demonstrated comparable effectiveness to antidepressants, and maintenance sessions can help prevent relapse.

    Pharmacotherapy for Depression

    • Tricyclic Antidepressants (TCAs): Block the reuptake of norepinephrine and/or serotonin.
    • Monoamine Oxidase Inhibitors (MAOIs): Inhibit the MAO enzyme, preventing the breakdown of norepinephrine, serotonin, and dopamine.
    • Selective Serotonin Reuptake Inhibitors (SSRIs): Primarily target serotonin, blocking its reuptake.
      • Common side effects: nausea, insomnia, sedation, and sexual dysfunction
    • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Block the reuptake of both serotonin and norepinephrine.
      • Examples: (des)venlafaxine (Effexor), Remeron (mirtazapine).
    • Medications Targeting Dopamine:
      • Examples: modafinil and pramipexole (stimulant-like).
    • Other Miscellaneous Actions:
      • Newer medications, such as ketamine, are effective for severe depression (similar effect sizes to electroconvulsive therapy (ECT)).
    • While precise mechanisms of action for antidepressants are not fully understood, we have a better understanding of the neurotransmitter systems involved.

    Introduction to Psychopathology

    • It is important to avoid pathologizing sadness, as almost everyone experiences transient periods of both sadness and joy. - Emotions serve important functions. Sadness can communicate a need for help, signal a need for change, or help conserve energy.

    • Mood exists on a spectrum, ranging from mild and transient to severe and persistent.

    Major Depressive Disorder

    • The prevalence of major depressive disorder (MDD) is estimated at 5%-12.5%.

      • Half of those who experience one episode will have another.
      • Approximately 90% of those who have two or three episodes will experience more.

    • The average episode duration is 6-9 months but can vary.

    • The average age of onset is typically in the early to mid-20s, but the onset age has been decreasing, with more teens being diagnosed.

    • Women are at a higher risk of developing MDD at all ages.

    • MDD often co-occurs with anxiety disorders, which can contribute to a more severe and chronic course of the disorder.

    Major Depressive Disorder (DSM-5 Criteria)

    • To be diagnosed with MDD, an individual must experience at least five of the following symptoms for at least two weeks, with at least one symptom being either depressed mood or anhedonia.

      • Depressed Mood: Subjective report (feels sad, empty, hopeless) or observation made by others (appears tearful)
      • Anhedonia: Markedly diminished interest or pleasure in all, or almost all, activities (subjective or observation).
      • Significant weight loss when not dieting or weight gain (+5% in a month), or decrease in appetite nearly every day.
      • Insomnia or hypersomnia (usually +/- 2 hour change).
      • Psychomotor agitation or retardation nearly every day (observable, not merely subjective feelings of restlessness or being slowed down).

    • The symptoms must cause significant distress or impairment.

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    Description

    Explore the medications used in the treatment of bipolar disorder, focusing on the role of lithium and anticonvulsants. This quiz examines their mechanisms, effectiveness, and potential side effects. Test your knowledge on how these pharmacological interventions impact patient outcomes.

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