Understanding Bi-Polar Disorder

Thursday, January 28, 2016 SANGEET KHANNA MD

Bipolar Disorders

Bipolar Disorder effects patients and often runs in families. Infact Bi-polar disorder has the strongest hereditary factor of all forms of mental illness.Bipolar disoder is often diagnosed in patients who have rapid fluctuations in mood, they act impulsively, often during accute episodes reuqire little sleep, feel overly energized, exerise poor judgment and engage in dangerous and high risk behavior, and sexual promescuity.

When attempting to understand and categorize the various types of bipolar disorder it is important to keep 2 principals in mind. 1) Duration of Episode,  2) Frequency of Cycling .  Mania is characterized by a period of intense irritation that is characterized by hyperactivity, racing thoughts, Fast frantic speech. This condition is severe enough to cause social impairment.

 

                Characteristics Include

 

  1. Inconveniencing friends and family at odd hour of the night
  2. Gambling
  3. Abnormal sexual Behavior
  4. Poor Financial Decision Making
  5. Delusions  and hallucinations

Bipolar -1 Such symptoms must be prevelent for 7 days to be characterised as Bipolar -1

Bipolar -2 Such symptoms must be prevelent for 4 days to be characterised as Bipolar -2

Pharmacological Options Include

Lithium

Various Side effects include:  Tremor, Nausea, Vomiting, Conduction abnormalities, it may also lead to decreases in GFR,  there may also be acne vulgaris. Hypothyroidism,

 

Pre- Lithium Work Up

 

There are six major Contraindications for Lithium Therapy

 

  1. IT reduces T-3 and T-4 ( leading to Hypothyroidism
  2. It is Highly teratrogenic and contraindicated in pregnancy ( thus do a serum HCG Test)
  3. Check Serum Creatinine for GFR ..
  4. Electrolyte imbalance and Sick Sinus Syndrome
  5. Desensitizes ADH causing ( Polyuria and Poly Dipsia)
  6. Diuretics lead to an increase in Lithium absorption, with in the Kidney and may be toxic.

 

Carbamazepine

 

                This is  an anticonvulsant, that is a anti-manic agent and is used in cases of Lithium tolerance.

                Side effects : nausea, Diplopia (double vision ) , Drowsiness, Ataxia.

 

Valproic Acid-

Anticonvulsant that is effective in treating manic patients, It increases GABA activity ( GABA) is

a major inhibitory neurotransmitter.

 

LAMICTAL -

Lamotragine, A highly effective mood stabilizing medication, an important concern is a rare but life threatening condition called steven johnsons syndrome  that offen begins with a rash.
 Consult your doctor and stop taking the medication if you notice a new onset rash after recently starting Lamictal

 

 

 

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