Psychiatry & Psychotherapy Podcast The History and Nuances of Bipolar Illness
4 snips
Aug 2, 2018 Dr. Cummings, an experienced psychiatrist and educator, guides a lively tour of bipolar illness history and treatment. He traces its clinical signs and evolution, explains neurobiology and circadian links, and compares lithium, anticonvulsants, and antipsychotics. Practical topics include safety monitoring, cognitive effects, relapse prevention, sleep strategies, and psychotherapy goals.
AI Snips
Chapters
Transcript
Episode notes
Lithium Causes Thyroid And Skin Effects
- Lithium commonly causes hypothyroidism and can worsen psoriasis or cystic acne by increasing skin oil secretion.
- Hypothyroidism from lithium is managed easily with levothyroxine replacement when needed.
Kindling Led To Anticonvulsants For Bipolar
- Robert Post proposed kindling: recurrent mood episodes sensitize limbic circuits, prompting use of anticonvulsants as mood stabilizers.
- Carbamazepine and valproic acid emerged after this work; valproate can outperform lithium in rapid cyclers.
Lamotrigine Treats Bipolar Depression Not Mania
- Lamotrigine helps bipolar depression and reduces cycling but has minimal anti-manic efficacy and can rarely cause Stevens-Johnson syndrome.
- Slow titration (25–50 mg/week) cuts rash risk versus rapid titration that gave ~9% malignant rash.