Bipolar+Disorder

//Western Diagnosis// A bipolar disorder characterized by mood disturbance, psychomotor dysfunction, and vegetative symptoms 5% population affects genders equally --depressive forms predominate in women --manic forms predominate in men age of onset teens to 30’s

Etiology
1. genetics 2. stressors 3. personality a. extroverted, achievement oriented

Signs & Symptoms
1. 20% with unipolar develop bipolar within 5 yrs of onset of depression a. early onset depression: <25 yrs old b. frequent depression c. quick elevation of mood with tx d. family hx: 3 consecutive generations 2. sudden onset 3. shorter cycles than uni 4. short episodes: 3-6 months 5. depressive sxs like uni a. more psychomotor vegetation b. hypersomnia

a. elation b. irritability c. hostility d. rapid speech e. extreme activity f. lack of insight i. believe that they are at their best g. paranoid delusions h. racing thoughts i. distractable j. delusional grandiosity k. auditory and visual hallucinations l. need less sleep m. inexhaustible, impulsive, excessive
 * manic psychosis**

Treatment
1. lithium carbonate 300 mg 2-5x/day a. 0.3-0.8 mEq/L maintenance b. many side effects i. tremor ii. muscle spasms iii. N, V, D iv. thirst v. polydipsia vi. polyuria vii. acne viii. psoriasis ix. hypothyroidism x. nephrogenic diabetes xi. confusion xii. seizures xiii. arrhythmias c. flaxseed oil: helps decrease side effects; 1-3 tbsp/day 2. psychotherapy

Notes: People diagnosed w/ major depressive disorder before age 25 more likely to develop bipolar Quick response to treatment for unipolar depression may be an indicator of unmanifested bipolar

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//Medical Nutrition:// Definition: Characterized by periods of abnormally elevated mood (mania) and abnormally lowered mood (depression) • -BD is more common in MS patients than in the general population, also asthma and migraines • -BD is seen with eating disorders, PTSD, Obsessivecompulsive DO, substance abuse. • -BD is linked to schizophrenia, and is associated with enhanced sensitivity to dopamine, and there is increased production of NE, Serotonin, and dopamine. • -There are familial connections to BD and schizophrenia, and depressive disorders. • -Increased incidence in diagnosis in children, traumas and puberty are linked. • -Children and juveniles diagnosed with ADHD are at risk for developing BD. • -Glutamate seems to be up regulated in BD. • -The prefrontal cortex and hippocampus have reduced gray matter volume by 25-40%, as well as, decreased utilization of glucose and blood flow. • There is noted to be increased white matter hyperintensities which occur in demyelination, glial cell inflammation, brain ischemia linked axonal loss, or aging brains. There are actual cerebellar atrophic changes, which could contribute to dysregulation of communication between limbic and cortex regions. • This dysregulation is a major determinant of mood.

Treatment
• EPA/DHA greatly stabilizes mood stopping rapid mood cycling. They act like ca++ channel blockers, and switch cell to prostaglandin 3. • Lecithin (phosphatidylcholine) 15-30gm “marked improvement”- has been able to maintain patients on PC alone to prevent mania without lithium. • VitC, and Vitamin E • BVitamin • L-tryptophan is helpful in some studies, others not. High doses used –caused nausea. • 5-HTP has helped BD (50%) but can cause increase in serotonin inducing mania- must be watched. • Multi-min • Lifestyle changes • Dietary changes

• **Dosage:** Low dose (5mg) Lithium aspartate or orotate, (10-20mg/d) for normal brain function enhancement, found in drinking water in areas like Ashland. In these areas there is much less homicide and rage crimes. • **Manic depression**: 900-1800 mg lithium carbonate (SE: HBP, tremor, nausea, proteinuria • Hypothyroid with large doses, and fatty acid deficiency.)