Inkscape.org
Depression vector created by pch.vector - www.freepik.com and

I've come to notice that ever since my doc increased my antipsychotic from 5mg to 7mg (abilify), I'm finally clear-headed.

Example: I used to keep my keys in the car but I'm finally remembering them. I'm remembering a lot of stuff now.#bipolarclub

— Ros47Ron-"Bipolar can be a great teacher" (@Rons_Reads) September 26, 2022

In the last post we started a talk about genetics and the effects on mood disorders it was found to follow a mendalian inheritance pattern.

We talked about the significant risk that is seen in bipolar affective disorder and found that is this more common in depression.

We also took a look at the features to be considered before hospitalization like psychiatric clinical features mental state exam detail and the clinical features of depression as depression is a major cause of suicide.

Inkscape.org
Depression vector created by pch.vector - www.freepik.com and

My girlfriend who suffers from BPD is currently in a coma after trying to commit suicide by jumping from a 5 story balcony in Spain. We are currently fundraising for life saving treatment. Please share to to help raise awareness for mental health. Keep Tionne in your prayers 🙏🏽❤️ pic.twitter.com/i9UgF7yuiW

— Shadia 🌹 (@shadia_rashida) September 26, 2022

Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for two consecutive months. This month will be dedicated to BAD or Bipolar Affective Disorder. In the first month, we discussed Depression, and in the subsequent month, anxiety. We are done looking at a Nigerian study and now we are moving to Twitter posts.

Announcement!!!

We are moving to our new account after this month's topic. Follow us here @medicvibes

In this post, we are looking at this tweet that talks about Antipsychotics in Bipolar Affective Disorder. To learn more just keep scrolling down. You can also keep the explanatory parts of the post straight to the main topic.

Patients who are bipolar have these major depressive episodes and manic episodes. Mood disorders are also called affective disorders 2 months ago, we talked about depression, among the types of depression is Major Depressive Disorder which is otherwise known as unipolar depression.

Top Left King Saul, Top Right Hippocrates Bottom Left Robert Burton Bottom Right Anatomy of Melancholy

History
King Saul's features in the bible, were typical of mood disorders when he would have David play for him in his palace. Hippocrates believed depression was a result of black bile and he called it Melancholic (meaning Black Bile). The first person to describe depression in English text was done by Robert Burton. His book Anatomy of Melancholy dates back as far back as 1621. Emil Kraepelin developed the criteria that is still used for manic-depressive psychosis. It was called folie circularie.

Demographics
Among all the mood disorders BAD I has the earliest onset. The prevalence of BAD I is equal in men and women. Episodes of mania are seen more in men while depressive episodes occur more in women. Depression appears to have a higher occurrence in rural areas, there is a tendency for schizophrenia to be misdiagnosed by practitioners from a different culture from the patient.

Other Associated Conditions
People who deal with mood disorders are significantly at risk of dealing with alcohol abuse or dependence, anxiety disorders particularly panic, obsessive-compulsive and phobias, particularly for people and socialising. Women particularly have eating disorders when they go through unipolar and bipolar disorders. Biogenic amines affect the concentration and effect of the neurotransmitters at the synaptic cleft. Cholinergic agonists modulate the activities of the pathway between the hypothalamus, Pituitary gland and adrenal gland. GABA inhibits the action of monoamine pathways that ascend especially the mesocortical and mesolimbic.

Biology of BAD
The studies were done with Urinary Free Cortisol, 24 house intravenous taps for plasma cortisol, cortisol in saliva and a test of feedback inhibition. There are known documentation about the changes in hormone interplay in the brain and reactions that can be a result of early life stressors. Early trauma can lead to increased hypothalamic–pituitary–adrenal(HPA) activity which is followed by cerebral cortex volume depletion and cellular reduction. HPA activity is being referred to as a clear feature of mammalian stress and it is a link between depression and the biology of chronic stress. 60% of the time cortisol is not suppressed in the morning or it escapes suppression by 4 pm.

In 40% of outpatients with depression and 80% of inpatients, it is seen as easy arousal. The characteristics of this easy arousal are longer periods of nighttime awakeness, reduced sleep time, an increase in the Rapid Eye Movement (REM) phase of sleep and a rise in body temperature. Reduced secretion of growth hormone is linked with this reduced slow wave sleep. This is because there is increased REM drive and reduced fast-wave sleep that results in a reduced first period of non-Rapid Eye movement (NREM). These hyperintensities are seen more frequently in BAD I and elderly patients.

They are evidence of neurodegenerative affectation of the brain due to mood disorders. There are 4 regions in the brain that modern medicine believes are the seat of emotions - the prefrontal cortex, anterior cingulate, hippocampus, amygdala and amygdala. The ACC is believed to control emotions when stimulated especially when goals become harder to achieve because of problems. There are two divisions of the ACC - the affective and cognitive parts. The affective part is connected to the limbic region and the cognitive part to the prefrontal cortex. The cognitive part is connected to the PFC and other cortical parts of the brain.

Genetic Factors
There have been many families, adoption and twin studies that have outlined the fact that mood disorders might be inherited. What scientist are cracking their brain around these days is to find the specific molecules that can be attributed to this.

Family Studies
A child that has a parent with a mood disorder has a 10 to 25% chance of developing a mood disorders. A family that has more members affected has a greater chance. There is an even greater risk if the relatives that are affected are close relatives as opposed to being distant. When there is a severe form of the condition it also gives a picture of the genetic background to these conditions.

Adoption studies
To properly explain the cause of BAD it is good to separate environmental causes from genetic causes. One way to do that is to make studies on families that were formed by adoption. The problem is that there are limited studies that have been done on this. One of the biggest studies was done to assess this cause.

In this study, there was an increase threefold in the rate of bipolar disorder and a two-fold increase in the rate of unipolar disorder in bipolar genetic studies of probands (when considering the beginning of a genetic trait).

A Danish study had a similar finding when considering the suicide rates among probands. Other studies have not been able to be compelling enough and in them, there was no difference in rates of mood disorders.

Antipsychotics in BAD

Source

This treatment is divided into the acute phase and the maintenance phase. It also includes coming up with treatment for the different presentations of the patient like mania, hypomania or depression. Lithium has been a major drug used in therapy because of its antidepressant, antipsychotic and anxiolytics synergistic effect. In new times some anti-convulsants that have a mood stabilizing effect and atypical antipsychotics have been added. The major ones Carbamazepine, Valproate and Lamotrigen. Many of these drugs are used for acute mania.

The drug the tweet was referring to was an atypical antipsychotic known as Aliprprazole.

Among the different types of antipsychotics, only Aripiprazole, olanzapine and three others have been approved by the food and drug administration because of their proven effect on mania. When placed side by side with other antipsychotics the atypical antipsychotics do not come with the side effects of these other drugs. The typical Antipsychotics can cause an increase in prolactin that is not seen in the atypical ones. The main issue with the atypical antipsychotics is the increased chance of weight gain, the issues with insulin resistance, leading to diabetes and other cardiovascular side effects.

Aripiprazole is a very effective drug that helps with learning through vision and memory in general.

Tips for treatment

For some people with bipolar disorder, their symptoms can be managed by lifestyle changes alone. But for others, the only way they can manage their symptoms is through therapy, in particular psychoanalysis.

Psychoanalysis is an umbrella term for various talking therapies that focus on unearthing hidden conflicts and meanings in a patient’s psyche. It was developed as a treatment for neurotic disorders such as anxiety or depression. Psychoanalysis has been found to be even more effective when used alongside medication to treat bipolar disorder and other complex mental health conditions.

What we try to attain in psychoanalytic therapy is to fix the structure of the person's personality and not just teach coping mechanisms for each symptom. psychoanalytic therapy deals with its coping mechanisms, teaching how to grieve learning methods of building trust and building intimacy. This treatment usually takes the patient through periods of anxiety and stress and the treatment can go on for years.

Hive Stories

In this post by @matheusggr about sleep and psychoanalysis, sleep was defined and its premise used in psychoanalytic theory. The content of dreams and the direct and indirect meanings were explained with their relationship with psychoanalysis.

Read this post here

Questions

• What did you learn about mood disorders?
• What did you learn about Bipolar disorder?
• What did you learn about the use of antipsychotics in Bipolar Disorder?

Conclusion

There is more evidence to attest to a link between genetics and mood disorders as seen through adoption studies.

Antipsychotics are very effective means of treating BAD, however, what was not outlined is their effectiveness in memory problems

I hope that you learned a lot from this post.

To book me for illustration gigs click Here

References

• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
• Page demarcations made with Inkscape.org