Oscillating mood swings from melancholia of depression to elation of mania
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What are the 2 forms of BPD?
Type I = full blown episodes of mania and Type II = episodes of hypomania
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What is mania?
Patient feels energized, invincible, but insight & judgment are impaired
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What is rapid cycling?
When a patient has 4 or more BPD cycles in a year
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Discuss onset and predisposition.
Patients more likely to develop it at an earlier onset than unipolar depression and approx. 65% of sufferers have a family member with the condition
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Discuss symptoms of BPD.
Reduced need for sleep. Rapid speech. Delusions of grandeur/over-inflated self-esteem. Racing thoughts. Easily distracted. Psychomotor agitation. Risk-taking behaviour. Impaired judgement. Hallucinations/delusions. Requires hospitalisation to protect
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Discuss changes in brain activity.
There are structural brain changes including enlarged ventricles and an enlarged amygdala.
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Discuss medications to control BPD: Mood stabilisers.
Lithium, carbamazepine, sodium valproate and some other anticonvulsant agents
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Discuss medications to control BPD: Anti-manic agents
Describe the mechanism of action of lithium in BPD.
Reduces frequency of cycling & smooths extreme highs/lows in mood. Usually given in Type I. Specific MoA = unknown but Li+ alters Na+ transport = inhibitory effect on second messenger systems & reduces responsiveness to transmitters.
How can hyponatraemia be linked w/ antidepressant therapy?
Antidepressants can effect normal ADH regulation of blood volume/osmolarity. This effect is most common with lithium and SSRIs.
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What does the Committee on Safety of Medicines advise on hyponatraemia?
hyponatreamia should be considered in all patients who show symptoms of drowsiness, confusion or convulsions on antidepressants
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Valproic acid is used to treat manic episodes in BPD. Outline its mechanism.
Increases GABA neurotransmisison = enhances synthesis, turnover and release of GABA. Also inhibits Ca2+ influx through NMDA receptors while indirectly enhancing brain serotonergic function via GABA-ergic means
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What are the side effects of valproic acid?
GI effects, sedation, ataxia, tremor, hepatic effects, teratogenic, weight gain, enzyme inhibitor
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Carbamazepine prevents relapses in BPD and treats acute rapid cycling. How does it work?
Inhibits effects on second messenger systems. Inhibits Ca2+ influx through NMDA and GABA-B receptors. Stabilises NA+ channel mediated membrane and potentiates A2 adrenoceptors to reduce the release of NA
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What are the side effects of carbamazepine?
It is an enzyme inducer. Drowsiness, nausea, ataxia, headache
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Other cards in this set
Card 2
Front
What are the 2 forms of BPD?
Back
Type I = full blown episodes of mania and Type II = episodes of hypomania
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