Dysthymia
It is a disorder characterized by depressed mood that is less severe than major depression.
To be able to say 0 Dysthymia, the depressed mood must have been present for at least 2 years.
Antidepressants can be used in the treatment.
20-30% develop major depression and bipolar disorder.
Bipolar Disorder
0 Characterized by manic episode + depression or, rarely, mania alone.
Etiology:
• Heredity is important. The risk of being seen in first degree relatives is 25%.
Diagnosis and Typical Symptoms:
Complete criteria for mania according to DSM 5
A. Unusual elevated mood, increased energy and activity for at least 1 week.
B. At least 3 of the following symptoms (4 if the mood is irritable)
1. Increase in self-esteem, grandiosity
2. Decreased need for sleep
3. Don't talk more or keep talking
4. Flight of ideas
5. distractibility
6. Increase in goal-directed effectiveness
7. Excessive participation in activities that may end badly
C. Impaired social or occupational functioning, requiring hospitalization, or psychotic features
D. Unexplained symptoms by substance use or other medical condition
• Overspending
• Hypersexuality
• Unable to be blocked
• Vegetative symptoms (increased libido, weight loss, decreased need for sleep and food, excessive energy, insomnia)
• Strange shiny clothes
• Encoheran speech
• Neologism
• Clang connotation
Delusions in Mania:
It can and often is grandiose or paranoid.
Types of Bipolar Disorder
a. Bipolar I disorder:
manic episode + major depression
b. Bipolar II disorder:
Major depression + hypomanic episode
c. Rapid cycling bipolar disorder:
Having more than 4 mood episodes per year.
D. cyclothymic disorder:
There are mild depression + hypomanic episodes.
Symptoms must be present for at least 2 years.
Prognosis in Bipolar Disorder
• If untreated, a manic episode can last 3-6 months.
• It is a mood disorder with the highest risk of suicide.
Treatment:
• Mood stabilizers are the first choice.
• Drugs that do not increase the risk of having another attack while treating one attack are called mood stabilizers. They are used both during attack and for protection.
• The prototype of mood stabilizer drugs is lithium.
• Many antiepileptic drugs, especially valproate, carbamazepine and lamotrigine, have a mood stabilizing effect.
• Quetiapine is an antipsychotic drug with a mood stabilizing effect.
• Valproic acid is preferred in rapid cycling and mixed bipolar disorder.
• Antipsychotics can be added to the treatment in acute manic seizures.
• Antidepressants can be added to the treatment during depressive periods. However, antidepressants cannot be used alone without mood stabilizers in bipolar disorder.
Lithium
It is used in the form of lithium carbonate. It is completely excreted by the kidneys.
The therapeutic index is narrow. The dose should be adjusted by controlling the blood level.
Stabilizes the cell membrane.
It is thought to act through inhibition of inositol monophosphatase and glycogen synthase kinase-3.
It is used for both treatment and prophylaxis of bipolar depression and mania.
It can be used to strengthen treatment in unipolar depression.
It has a reducing effect on aggression and suicidal ideation.
Tests to be checked before treatment: Kidney-thyroid function tests, hemogram, EKG, pregnancy test
No KCFT follow-up is required.
Side effects of lithium:
GI: Nausea-vomiting, diarrhea
Tremor: Propranolol is used in its treatment.
Renal dysfunction, polyuria (with ADH antagonism, nephrogenic diabetes insipidus)
Arrhythmia, hypotension, benign reversible thyroid enlargement (prevents iodination), hypothyroidism, to a lesser extent hyperthyroidism
Teratogen (contraindicated in pregnancy), passes into milk.
It exacerbates skin lesions such as acne vulgaris and psoriasis.
Drug interactions of lithium:
NSAIDs, thiazides, ACE inhibitors may cause toxicity by reducing the renal clearance of lithium.
Dehydration, salt-free diet increases lithium reabsorption and toxicity may occur.
Lithium toxicity:
Begins above 2 mEq/L.
Confusion, lethargy, vomiting, severe tremor are seen.
Above 2.5 mEq/L, arrhythmias, clonic movements, seizures, circulatory collapse and coma occur.
In the treatment, the drug is discontinued, the patient is hydrated, hemodialysis is performed and anticonvulsants are given.