Question

JC is a 47-year-old male patient who is having difficulty sleeping. The patient is distraught, agitated...

  1. JC is a 47-year-old male patient who is having difficulty sleeping. The patient is distraught, agitated and presenting with manic symptoms. He is gainfully employed at an investment company, married with two children, both in college. There is no history of drug or alcohol abuse, he does not smoke cigarettes. His past medical history includes:
    1. Depression for which he has taken escitalopram 20mg daily for the past 6 years.
    2. HTN that is treated with HCTZ 25mg daily
    3. Hyperlipidemia treated with atorvastatin 20mg daily

Over the past several days, he has been distressed and focused on improving his ability to concentrate and function better. You know that

  • mood stabilizers
  • lithium
  • stimulants
  • antidepressants
  • antipsychotics
  • benzodiazepines

all have potential uses in bipolar. What symptoms might each medication or class of medications target? What would be the benefits and limitations of each for this particular patient?

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Answer #1

Mood stabilizers:

It helps in treating depression in bipolar and thereby reducing the effects of mania. It regulates emotions and reduces the frequency of mood changes.

Benefits:

  • It is beneficial in treating bipolar disorder.
  • Reduces the mood wings and distress of the patient.

Limitations:

  • It raises high blood levels.
  • Long term use increases side effects.

Lithium

It reduces the frequency and severity of agitation and manic symptoms.

Benefits:

  • It stabilizes the emotion.
  • It strengthens the nerve cell and thereby improve the patient function.

Limitations:

  • The dose should be adjusted according to body function.
  • Overdose may lead to blood volume depletion.

Stimulants

It is a class of drug used to treat the symptoms of hyperactivity or attention deficit disorder.

Benefits:

  • It focuses on activities and increases concentration.
  • It regulates the blood pressure, BP, heart rate and temperature.

Limitation:

  • It affects appetite and sleep disturbances.
  • Long term use leads to memory problems.

Antidepressants

It stabilizes the mood through the stimulation of neurotransmitters.

Benefits:

  • It increases appetite, sleep, and concentration.
  • It increases the positive mood.

Limitation:

  • It increases the side effects such as insomnia, tremors, restlessness, constipation.
  • It increases suicidal thoughts.

Antipsychotics

It is used to treat psychotic disorders.

Benefits:

  • It reduces the delusions and hallucinations.
  • It reduces psychotic symptoms.

Limitation:

  • It increases the trembling or stiffening of muscles.
  • It leads to uncontrollable movement.

Benzodiazepines

It helps to reduce the symptom of anxiety.

Benefit:

  • It improves the sleep pattern in the patient.
  • It helps to relax the muscles and improves the function.

Limitation:

  • It increases drowsiness and sleepiness.
  • Intake of medication Interacts with alcohol.
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