{"id":2732,"date":"2010-02-13T19:24:06","date_gmt":"2010-02-14T00:24:06","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=2732"},"modified":"2010-02-13T19:54:28","modified_gmt":"2010-02-14T00:54:28","slug":"bipolar-disease","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2010\/02\/bipolar-disease\/","title":{"rendered":"Bipolar Disease"},"content":{"rendered":"
1)<\/strong> psychiatric disorder marked by unpredictable swings in mood from mania to depression 2)<\/strong> variants exist where there are repeated manic episodes without the intervening depressive episodes and vice versa 3)<\/strong> rapid cycling variant – four or more episodes of mania or depression per year<\/p>\n Signs and Symptoms<\/strong><\/p>\n Manic phase<\/em> – 1)<\/strong> increased psychomotor activity 2)<\/strong> decreased need for sleep 3)<\/strong> excessive social extroversion 4)<\/strong> impulsive actions 5)<\/strong> irritability 6)<\/strong> grandiose delusions 7)<\/strong> paranoia Depressive phase<\/em> – 8)<\/strong> loss of interest in life or surroundings 9)<\/strong> decreased libido 10)<\/strong> significant weight gain or loss 11)<\/strong> feelings of fatigue and tiredness 12)<\/strong> sleep disturbances 13)<\/strong> feelings of hopelessness and intense sadness<\/p>\n Characteristic Test Findings<\/strong><\/p>\n Radiology<\/em> – abnormally high incidence of subcortical white matter abnormalities<\/p>\n Associated Conditions<\/strong><\/p>\n 1)<\/strong> strong genetic predisposition (30% concordance rate in monozygotic twins) 2)<\/strong> altered circadian rhythms<\/p>\n Biochemistry<\/strong><\/p>\n exact underlying biology is unknown but may involve alterations in glutamate regulation<\/p>\n Inheritance\/Epidemiology<\/strong><\/p>\n 1)<\/strong> affects 3 million people in USA 2)<\/strong> occurs roughly equally in men and women, but men have more manic episodes and women have more depressive episodes 3)<\/strong> age of onset is most common in late teens to age 30 4)<\/strong> prognosis is mixed, with 50% of patients unable to function normally in work and psychosocial roles even with treatment<\/p>\n Treatment<\/strong><\/p>\n 1)<\/strong> lithium and valproate are mainstays of treatment 2)<\/strong> common adjunctive drugs – carbamazepine and lamotrigine 3) antidepressants – used if depressive phase is severe but should not be started in maintenance phase, as they may precipitate a manic breakthrough<\/p>\n Tips for USMLE<\/strong><\/p>\n if a 23 year old man returns home from graduate school and excitedly tells his family that he is quitting school because he has founded a company that he is sure will revolutionize the computer industry and he is so confident of his success that he has purchased (on credit) a Mercedes Benz and 500 bottles of expensive wine, think bipolar disease
\nPathophysiology<\/strong><\/p>\n
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