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Lecture Twelve

Bipolar Disorders and Eating Disorders

**Define Bipolar Disorder Alternations between mania/hypomania and depression, with intervening asymptomatic periods.
What general characteristics does mania involve? hyperactivity, elation, impulsiveness, aggressiveness, racing thoughts hallucinations
What general characteristics does depression involve? sadness, worthlessness, anergia, insomnia, anhedonia, suicidal ideation
**Diagnosing bipolar is difficult because...? it requires a long-term case analysis and exclusionary diagnoses
**What is bipolar often initially misdiagnosed as? unipolar depression
**only ~ 1-5% prevalence of bipolar disorder worldwide, but is very _________! Costly
**Bipolar Disorder brings high ___________ to the individual and high __________ _____ morbidity, social costs. read over these
**There are two types of pharmacotherapy for BD. Describe them Monotherapy using the mood stabilizer called Lithium. Combination therapy using the mood stabilizer + one of the following: anxiolytic, antipsychotic, antidepressant, neuromodulator or Symbax
Lithium has shown efficacy for bipolar disorder since the 1970s. Around the 2010s came controversy. **What is the first concerns over lithium? 1) Very narrow therapeutic range: so risk of GI and neurological toxicity (pancreatitis, gastrisis) with side effects and long half life. So requires frequent blood monitoring to get concentration of lithium right - make sure not too high.
**What is the second concern over lithium? Dietry Compliance where you have to have controlled salt regulation (low salt diet) because of Na+ levels and have to have high fluid/water intake. So requires dietry instructions, understanding and compliance.
**What is the mechanism of Lithium? nobody knows!
**If you have given the bipolar patient the mood stabilizer Lithium, but they are still having manic or depressed episodes, what do you need to do? Do combination therapy so add another drug to treatment.
**If you need to give the bipolar patient a combination treatment because they are still having manic and depressed episodes and they are also anxious. What should you give them? Benzodiazipine as its safer, so not barbiturate as they can commit suicide with barbiturate)
**If you need to give the bipolar patient a combination treatment because they are still having manic and depressed episodes, and you decide to give them an anti-psychotic, describe concerns/ideas about this... You would not give a 1st generation drug due to the side effects (PD and hormonal symptoms) so you would give them 2nd generation even though they still have side effects.
**If you need to give the bipolar patient a combination treatment because they are still having manic and depressed episodes, and you decide to give them an anti-depressant, describe concerns/ideas about this... You would not give MAOI because of the shortcomings (drug-drug and drug-food interactions) and not TACs due to shortcomings. So would start with SSRIs (but be aware of the 1month delay so compliant issue and risk of causing flip to mania
**If you need to give the bipolar patient a combination treatment because they are still having manic and depressed episodes, and you decide to give them a neuromodulator, describe concerns/ideas about this... used in epilepsy and is traditionally the first line of combination treatment to put with Lithium
**What is the mechanism of action for neuromodulators? prolongs Na+ channel (so they can't repeatedly activate) and inhibits GABA transporter (so more inhibition)
**Name the two examples of neuromodulators: Tegretol and Lamictal
**What does the neuromodulator Tegretol do? It reduces the frequency of episodes in BD if used prophylactivally (take it all the time to prevent episodes (not acutely when you have an episode))
**What are the mechanisms of Tegretol? Prolongs Na+ channel inactivations state and potentiates/increases GABA transmission
**What is the key point about Lamictal? becoming 1st line monotherapy (not combination therapy) for less severe BD.
**What is the mechanism of action for Lamictal? reduces voltage-gated Na+ channel conductance
**More recently, a drug called Symbax was designed to add to Lithium and includes and anti-_______________ and an anti-____________? anti-depressant and anti-psychotic.
**What exactly/specifically is inside a Symbax pill? 1) a drug called Alanzapine which is an atypical anti-psychotic with MOA: antagonist for D2 receptor and 5-HT2 receptors. 2) Fluxetine (Prozac) which is a SSRI anti-depressant with MAO: inhibits SERT
**Describe the 3 pharmacotherapy in BD. 1) Polypharmacy: *overwhelming polycompliance as have to take each drug as prescribed, when prescribed, *with drug-drug interactions as a concern. 2) Face lifetime treatment:will have BD and be medicated whole life. 3) Need to have good patent education.
**Patients with Anorexia have very low body weight. ___% lower than the norm 85% lower body weight
**What is the nature of the weight loss in Anorexia? Ego-syntonic weight loss with fear, anxiety and distorted perceptions.
**What is the body weight like for Bulimia? Usually normal.
**Compare and contrast anorexia and bulimia. Anorexia: very low bodyweight(85%<than normal)while Bulimia involves normal weight.Anorexia's weight loss is ego-syntonic w/ fear,anxiety &distorted perceptions.Bulimia involves recurring loss of restraint,resulting in cycles of bingeeating&compens. behav
** Bulimia what are the four compensating behaviours they do after binge eating? 1) Vomiting 3) Exercise intensely 3) Restricting/not eating 4) Drugs such as laxatives, diuretics and psychostimulants as they depress appetite.
**Name the 3/4 challenges of pharmacotherapy for EDs . Read over others 1) A lot of drugs require food to be taken with the drug. 2) EDs cause CV risks so this will be enhanced if take drugs that also cause CV 3) Vomiting if taken orally as can't get past the GI tract so have no effect.
**Name the 4th challenges of pharmacotherapy for EDs . Read over others 4) Due to malnutrition, organs needed to metabolise, eliminate etc may not be working e.g. liver, kidney . And due to malnutrition chemicals such as serotonin and dopamine cannot be made so impairs cognitive capacity so less likely to take drug.
**what generation of anti-psychotics is better for ED? And why Second generation . Because they still cause weight gain and exhibit good efficacy in people with ED for reducing obsessive tendency, negative body image and anxiety about eating,
**How are anti-depressants used in EDs? To treat comorbid depression with critical eye for suicide risk
**For treatment of Anorexa, what are the critical things to focus on? Weight gain, psychotherapy. If there is a comorbid condition such as depression present then drug use may be considered but with extreme caution due to physical vulnerability.
**For treatment of Bulimia Nervosa was are the critical things to focus on? Psychotherapy. Medication can be a beneficial adjunct but not good for BM by itself!
Created by: alice476