Behavioral Science - Bipolar Disorder - Thomas L. Schwartz Flashcards
Increased self esteem/grandiosity; Decreased sleep; Increased speech; Racing thoughts; Distractibility; Increased activity (energy); Increased dangerous impulsivity
These are symptoms of:
Mania
Must have 3 persisting for at least 7 days
Must cause distress or dysfunction
Cannot be due to another disorder
What does DTRHIGH stand for?
Distractible Talkative Racing Thoughts Hyperactive Impulsive Grandiose Hyposomnic
Mania symptoms
How is hypomania different from full blown mania?
Milder;
At least 4 days or more
Same symptoms as mania
Symptoms provide a chage in personality, noticeable by others
Not severe enough to cause marked impairment
Can you have both mania and depression at the same time?
Yes, called a “mixed episode”
What is rapid cycling?
4 or more episodes per year
bipolar disorder
T/F: 10% of bipolar disorder sufferers have only mania and no depression.
True
Cyclothymia is composed of:
hypomania (2+ years) and periods of minor depression
Suicidality increased in these patients bc the blow of the depression is a severe difference from their previous feelings
How long must a period of depression persist to meet the criteria for dysthymia?
2+ years
The average patient spends ____ months in a euthymic state.
6
What is the Kindling Hypothesis?
Too much neuronal limbic firing
Low receptor, high chemical
What is the prevalence of bipolar 1 among men and women?
1%, the same in both genders
Women have a greater occurrence of what kind of bipolar disorder than men?
Bipolar 2
How can stress increase manic symptoms?
Less sleep, disruption of circadian rhythms;
Lower med compliance;
Increase substance abuse
How does psychotherapy work for manic episodes of bipolar disorder?
It doesn’t
During maintenance however, it can be helpful
Antimanic agents:
Lithium
Divalproex - increases GABA
Carbamazepine - blocks Na channels and promotes neuronal health;
atypical antipsychotics - all block D2 receptors and increase connectivity (risperidone, aripiprazole, olanzapine, asenapine)
A patient has mania and you want to prescribe a treatment. Which property below would you like to manipulate by way of prescribing?
A. Block Na+ channels to slow neuronal firing
B. Stimulate D2 receptors to increase limbic activity
C. Increase NE release robustly into synapse
A. Block Na+ channels to slow neuronal firing
ie Lamotrigine
A 40 yo patient has had bipolar 2 disorder for 15 years but comes to your office in a fully mani state that has lasted 14 days. What is the correct diagnosis?
A. Cyclothymia
B. Bipolar 2
C. Bipolar 1
C. Bipolar 1
What is the DSM 5 criteria for mania?
distinct, abnormal, elevated, expansive mood that persists for at least 7 days
3 or more characteristic symptoms that persist for at least 2 weeks
(Goal directed hyperactivity must be present)
must cause distress/dysfunction
Cannot be due to another disorder/condition/substance use
What are the 7 characteristics of mania?
DR. HIGETH
Distractable Racing thoughts Hyperactivity (goal oriented) Impulsive Grandiose Elevated mood (Euphoria) Talkative Hyposomnia
How is hypomania different from mania?
milder form of mania
symptoms must persist for at least 4 vs 7 days and cause unequivocal change in function/personality noticeable by others but not severe enough to cause marked impaiment
*must still cause distress/dysfunction and can’t be due to another conidition/drug
Criteria for Major Depressive Episode
pervaseives sadness, down, irritable (lasts more than 2 weeks)
Must cause distress/disfunction and can’t be due to something else
What is difference between cyclothymia and dysthymia?
opposites - low level mania vs low level depression for 2+ years
euthymia = normal mood in psychobable
hyperthymia is similar but less severe to cyclothymia
What is a mixed episode?
Meets criteria for both Mania and Major depressive episode
