Bipolar Flashcards
Mania vs. Hypomania: Mood and activity level: For both 1. Mood is \_\_\_\_\_\_, \_\_\_\_\_ OR \_\_\_\_\_\_\_\_\_\_\_
- Increased goal directed _____ or ______
Abnormally and Persistently
Elevated, expansive
OR
Irritable
- Activity or energy
Mania vs. Hypomania:
Duration for mania
- 1 week (any duration if hospitalization necessary - even only one day)
- Most days, nearly every day
Mania vs. Hypomania:
Duration for hypomania
- 4 days
- most days, nearly every day
Mania vs. Hypomania: Functional Impairment for Mania: Sxs lead to.... 1. OR 2. OR 3.
Functional impairment OR Psychotic features OR Hospitalization to prevent harm to self or others
Mania vs. Hypomania: Functional Impairment for Hypomania: Sxs do not lead to.... 1. OR 2. OR 3.
Functional impairment OR Psychotic features OR Hospitalization to prevent harm to self or others
Mania vs. Hypomania:
Sxs for both:
3 additional symptoms (need 4 if mood is only irritable)
- Inflated ___ or ____
- Decreased need for _____
- Increased ______ or pressured ______
- ______ideas or thoughts _______
- Distra______
- Increased goal ______ activity or psychomotor ______
- Excessive involvement in _______ activities that have ______ potential for painful consequences.
- Self esteem or grandiosity
- sleep
- talkativeness; pressured speech
- Flight of ideas; thoughts racing
- Distractibility
- goal directed activity; psychomotor agitation
- pleasurable activities; high potential
Mania vs. Hypomania:
Substance:
For both:
- Sxs not attributable to _______
- Sxs caused by _______ Tx (med or ECT) count if they continue ______ after Tx stops
- Hypomania exception: if only _____ or ____ Sx (esp. irritability, edginess, agitation) due to antidepressant Tx then they do not count.
substance
antidepressant
continue on at full level
1 or 2 Sxs
BP-I vs. BP-II vs. Cyclothymia Requirements for Dx: BP-I Need more than 1 \_\_\_\_\_\_ episode Do not need a \_\_\_\_\_ episode for BP-I
manic; depressive
BP-I vs. BP-II vs. Cyclothymia Requirements for Dx: BP-II Need more than 1 \_\_\_\_\_\_ episode AND More than 1 \_\_\_\_\_\_ episodes
hypomanic; depressive
BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Cyclothymia
More than 2 year period of subclinical Sxs of _______ and ________
hypomania; depression
BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous BP-I
Can be ______ only
mania
BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous BP-II
No ______ episode
manic
BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous Cyclothymia
No _______, _______, or _________
major depressive, manic, or hypomanic episodes
BP-I vs. BP-II vs. Cyclothymia Requirements for Dx: Timing for Cyclothymia: Sxs present at least \_\_\_\_\_\_ time AND Not without Sxs for more than \_\_\_\_\_\_ at a time
half; two months
BP-I vs. BP-II vs. Cyclothymia
Impairment:
BP-I
Due to _____ (or _____ if present) episodes
manic; or depressive
BP-I vs. BP-II vs. Cyclothymia Impairment: BP-II Due to \_\_\_\_\_\_ episode OR unpredictability of \_\_\_\_\_\_
depressive; mood swings
BP-I vs. BP-II vs. Cyclothymia
Impairment:
Cyclothymia
Sxs cause significant ______ or ______ in functioning
distress; impairment
BP-I vs. BP-II vs. Cyclothymia
Exclusion Criteria:
BP-I, BP-II, & Cyclothymia
Not better explained by…(5 choices)
- Schizoaffective
- Schizophrenia,
- Schizophreniform
- Specified or Unspecified Psychotic Dx
- Delusional Dx
BP-I vs. BP-II vs. Cyclothymia
Children and Adolescents:
BP-I & BP-II
Children and adolescents _______
not mentioned
BP-I vs. BP-II vs. Cyclothymia
Cyclothymia:
Children and Adolescents:
_____ period for children and adolescents versus ____ period for adults
1 year; 2 year
BP-I vs. BP-II vs. Cyclothymia
Specifier-All
With _______ distress
anxious
BP-I vs. BP-II vs. Cyclothymia
Severity Specifiers:
BP-I and BP-II
Severity ______, ______, ______, or with _______
mild, moderate, severe, or with psychotic features
BP-I vs. BP-II vs. Cyclothymia
Course Specifiers:
BP-I and BP-II
______ or _______ remission
Full or partial remission
BP-I vs. BP-II vs. Cyclothymia Feature Specifiers: BP-I and BP-II 1. Mixed \_\_\_\_\_\_ 2. Rapid \_\_\_\_\_\_ 3. With mood-\_\_\_\_\_\_\_ or mood-\_\_\_\_\_\_\_ psychotic features 4. With cata\_\_\_\_\_ 5. With peri\_\_\_\_\_\_ \_\_\_\_\_ 6. With seasonal \_\_\_\_\_\_ 7. With mela\_\_\_\_\_\_ \_\_\_\_\_ 8. With aty\_\_\_\_\_ \_\_\_\_\_
- features
- cycling
- mood-congruent; mood-incongruent
- catatonia
- peripartum onset
- seasonal pattern
- melancholic features
- atypical features
BP-I vs. BP-II vs. Cyclothymia
All cannot be attributable to _______
substance
Mixed Features Specifier for Bipolar:
If meeting criteria for manic or hypomanic, plus three of the following:
1. Prominent ______ or ________ mood
2. Anh_____
3. Psychomotor _______ (observable by others)
4. Fatigue or _______
5. Feeling ______ or inappropriate _______
6. Recurrent thoughts of _____, ______/______/or ______
- dysphoria; depressed
- anhedonia
- retardation
- loss of energy
- worthless; guilt
- death, suicidal ideation, plan, or attempt
Mixed Features Specifier for Bipolar:
If meeting criteria for Major Depressive Disorder, plus three of the following:
1. Elevated or _______ mood
2. Inflated ______ or _______
3. Increased _______ or pressured _______
4. Flight of ______ or thoughts _______
5. Increased goal _______
6. Excessive involvement in _______ activities that have _____ potential for painful consequences
7. Decreased need for ______
- expansive
- self-esteem; grandiosity
- talkativeness; speech
- ideas; racing
- directed activity
- pleasurable; high
- sleep
Mixed Features Specifier for Bipolar:
If criteria met for full episode of mania and depression simultaneously then Dx……
Manic Episode with Mixed Features
Rapid-Cycling Specifier for Bipolar:
Can be applied to BP-I or BP-II:
1. More than ____ mood episodes in prior ____ months
2. Episodes = _____ or _____ remission for more than ____ months or _____ switch
3. Note: Substance induced episodes _______
4. Note: Manic and hypomanic are counted as _________
- 4; 12
- Full or partial; 2; polarity
- not counted
- the same pole
With Psychotic Features Specifier: Mood Congruent = themes of: 1. 2. 3.
- grandiosity
- invulnerability
- paranoia - especially doubts about other’s capabilities
With Seasonal Pattern specifier:
Only need ___ of the _____ poles (____/_____ or depressed) to occur with seasonal variation - not both.
More common in BP-II than BP-I
1; 2 (manic/hypomanic or depressed)
Differential Dx
Worse in BP-I, BP-II, or Unipolar:
Impairment: Impairment level can be ________
similar across all types
Differential Dx
Worse in BP-I, BP-II, or Unipolar:
Suicide attempts:
_____ data if any ______ in one BP subtype than the other
Mixed; higher
Differential Dx
Worse in BP-I, BP-II, or Unipolar:
Psychosis:
Highest in ______
BP-I
Differential Dx
BP-I and BP-II
More _______ agitation in their depression than unipolar
psychomotor
Differential Dx
BP-I and BP-II
Depression _____ in morning and more early morning awakenings than unipolar
worst
Differential Dx
BP-I and BP-II
Greater ________ concentrating than unipolar
difficulty
Bipolar prevalence
~ 1%
Bipolar onset
Avg is 18-20 y.o.
20% of cases onside is less than 13 years
Bipolar sex ratio:
In children
Males > Females
Bipolar sex ratio:
In adults
Males = Females
Bipolar comorbidity:
1.
2.
3.
- Anxiety Dxs
- Substance Dxs
- Borderline PD
Bipolar Suicidality:
_____ higher in BP than general population
14x
Bipolar: Depressive/Manic Balance:
For majority of cases the number of depressive episodes ____ than the number of manic/hypomanic episodes
is greater
Kindling
As you get older the time between episodes tends to shorten
Increased sensitivity model is best supported - idea is that you need less environmental stress to trigger an episode
Shows importance of treating early and aggressively before getting into kindling cycle
Bipolar genetics
High or low heritability?
High heritability rate
.85 to .93
Bipolar neurotransmitters involved
Dopamine
Serotonin
Med Tx for Bipolar:
Lithium side effects
Toxic range is next to therapeutic range
Hand tremors, weight gain, thirst
Med Tx for Bipolar:
AEDs Anti-epileptic drugs
Side effects
Potential teratogens
Stevens-Johnson Syndrome
Meds - Acute Mania
Lithium is ______ at addressing mania than antipsychotic meds and there is ______ between among AEDs and Li.
slower; no noteworthy difference
Meds - Depressive phase
Antipsychotics
1.
AEDs
2.
- Latuda
2. Lamictal
Meds - Prophylactic/Maintenance:
Lithium is an ______
Especially in preventing _______ phase.
Lamictal has prophylactic efficacy for the ______ pole and may be better for _______
effective prophylaxis agent; manic; depressive; BP-II
Psychotherapy Tx: Acute phase: Very limited evidence to support use of: 1. 2. 3.
- CBT
- Interpersonal
- Social Rhythm
Psychotherapy Tx: Maintenance phase: Psychoeducation effects are.... 1. Decrease in \_\_\_\_\_ 2. Increase in overall \_\_\_\_\_\_ Effects are likely due to... 1. Increased \_\_\_\_\_ adherence 2. Increase in \_\_\_\_\_ habits 3. Increase \_\_\_\_\_ for/recognition when \_\_\_\_\_\_\_
- relapse
- overall functioning
- medication
- regular habits
- planning; deteriorating
Peds BP:
Irritability is ______ found in Peds BP
frequently
Peds BP:
Irritability is not unique to Peds BP.
What other Dxs can express irritability?
Name 6
MDD Persistent Depressive Dx Generalized Anxiety Dx PTSD Oppositional Defiant Dx Disruptive Mood Dysregulation Dx
Peds BP:
Popularity of Dx
~ 60% of medical visits where the child received this Dx outpatient the Tx was….
polypharmacy
Peds BP:
~ 48% of those visits the Tx included an _______
atypical antipsychotic
Peds BP:
Increase in diagnosis occurred between _____ and _______ as a reason for psychiatric inpatient admit.
BP increased ______ and adolescent _____ in this timeframe.
Childhood unipolar depression only rose ______
1997 and 2004
438%; 296%; 17%
Peds BP:
Narrow Phenotype
Follows DSM-5
OR
More _____ - Requires “______” Sx of _______ mood and/or _______
rigorous; “cardinal”; elated mood; grandiosity
Peds BP:
Broad Phenotype
Ultra-______ rapid _____
Comorbid _______
Rageful _______
Ir______
ultra; cycling
ADHD
reactions
Irritability
Peds BP:
DSM-5’s Solution
Disruptive Mood Dysregulation Dx is created to __________
decrease incidence of BP in youth
Peds BP:
DSM-5’s Solution
Placed with unipolar because DSM says….
irritability associated with later unipolar (not BP)
DMDD Diagnostics:
A. Severe, recurrent _______ _____, manifested verbally and/or ______ that are ______ out of proportion in _____ or ______ to the situation or _________
temper outbursts; behaviorally; grossly; intensity; duration; provocation
DMDD Diagnostics:
B. Outbursts are _______ with _______ level
inconsistent; developmental
DMDD Diagnostics:
C. Outbursts occur more than _______ times per week (average)
3 times per week
DMDD Diagnostics:
D. The _____ between outbursts is persistently _______ or ______ most of the day, nearly ______ day, and observable ________
mood; irritable; angry; every; by others
DMDD Diagnostics:
E. Criteria _____- _____ present more than _____ months with no period more than ______ months without all ______ in Criteria A-D
A-D; 12 months; 3 months; symptoms
DMDD Diagnostics:
F. Do not make diagnosis for 1st time before _____ and after ______.
age of 6; after age of 18
DMDD Diagnostics:
G. (By Hx or observation) age of onset for criteria A-E is less than _____ years
10
DMDD Diagnostics:
H. _____ been a distinct period of more than ____ where they met full Sx criteria for _____ or _______
Never; 1 day; mania or hypomania
DMDD Diagnostics:
I. ______ do not occur exclusively during ______ and are not better explained by another mental Dx
(Note: This Dx CANNOT co exist with ODD, Intermittent Explosive Dx, or Bipolar.
If criteria for DMDD and ODD then only given DMDD)
Behaviors; MDD
DMDD Diagnostics:
J. Not attributable to _____ or other ______
substance; medical condition
DMDD
Comorbidity:
If could Dx with ODD then those with DMDD would be at 54 to 103x greater risk of having…
ODD
DMDD
Comorbidity:
ICD made DMDD a specifier of _____ for those with chronic _____
ODD; irritability
DMDD
Course:
Only ______ maintained a Dx 2-3 years later
14-19%
DMDD
Genetics:
Offspring whose parents had ______ are 5.4x more likely to have DMDD
BP
DMDD
Tx:
1. Parent ______
2. IPT - for ____ and _____
- training
2. for mood and dysregulation