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Adv. Psychopathology Midterm > Bipolar > Flashcards

Bipolar Flashcards

1
Q 
Mania vs. Hypomania:
Mood and activity level:
For both
1. Mood is \_\_\_\_\_\_, \_\_\_\_\_
OR
\_\_\_\_\_\_\_\_\_\_\_
  1. Increased goal directed _____ or ______
A

Abnormally and Persistently

Elevated, expansive
OR
Irritable

  1. Activity or energy
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2
Q

Mania vs. Hypomania:

Duration for mania

A
  • 1 week (any duration if hospitalization necessary - even only one day)
  • Most days, nearly every day
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3
Q

Mania vs. Hypomania:

Duration for hypomania

A
  • 4 days

- most days, nearly every day

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4
Q 
Mania vs. Hypomania:
Functional Impairment for Mania:
Sxs lead to....
1. 
OR
2. 
OR
3.
A 
Functional impairment
OR
Psychotic features
OR
Hospitalization to prevent harm to self or others
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5
Q 
Mania vs. Hypomania:
Functional Impairment for Hypomania:
Sxs do not lead to....
1. 
OR
2. 
OR
3.
A 
Functional impairment
OR
Psychotic features
OR
Hospitalization to prevent harm to self or others
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6
Q

Mania vs. Hypomania:
Sxs for both:
3 additional symptoms (need 4 if mood is only irritable)

  1. Inflated ___ or ____
  2. Decreased need for _____
  3. Increased ______ or pressured ______
  4. ______ideas or thoughts _______
  5. Distra______
  6. Increased goal ______ activity or psychomotor ______
  7. Excessive involvement in _______ activities that have ______ potential for painful consequences.
A
  1. Self esteem or grandiosity
  2. sleep
  3. talkativeness; pressured speech
  4. Flight of ideas; thoughts racing
  5. Distractibility
  6. goal directed activity; psychomotor agitation
  7. pleasurable activities; high potential
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7
Q

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.
A

substance

antidepressant

continue on at full level

1 or 2 Sxs

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8
Q 
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
A

manic; depressive

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9
Q 
BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
BP-II
Need more than 1 \_\_\_\_\_\_ episode 
AND
More than 1 \_\_\_\_\_\_ episodes
A

hypomanic; depressive

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10
Q

BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Cyclothymia
More than 2 year period of subclinical Sxs of _______ and ________

A

hypomania; depression

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11
Q

BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous BP-I
Can be ______ only

A

mania

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12
Q

BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous BP-II
No ______ episode

A

manic

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13
Q

BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous Cyclothymia
No _______, _______, or _________

A

major depressive, manic, or hypomanic episodes

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14
Q 
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
A

half; two months

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15
Q

BP-I vs. BP-II vs. Cyclothymia
Impairment:
BP-I
Due to _____ (or _____ if present) episodes

A

manic; or depressive

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16
Q 
BP-I vs. BP-II vs. Cyclothymia
Impairment:
BP-II
Due to \_\_\_\_\_\_ episode 
OR unpredictability of \_\_\_\_\_\_
A

depressive; mood swings

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17
Q

BP-I vs. BP-II vs. Cyclothymia
Impairment:
Cyclothymia
Sxs cause significant ______ or ______ in functioning

A

distress; impairment

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18
Q

BP-I vs. BP-II vs. Cyclothymia
Exclusion Criteria:
BP-I, BP-II, & Cyclothymia
Not better explained by…(5 choices)

A
  • Schizoaffective
  • Schizophrenia,
  • Schizophreniform
  • Specified or Unspecified Psychotic Dx
  • Delusional Dx
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19
Q

BP-I vs. BP-II vs. Cyclothymia
Children and Adolescents:
BP-I & BP-II
Children and adolescents _______

A

not mentioned

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20
Q

BP-I vs. BP-II vs. Cyclothymia
Cyclothymia:
Children and Adolescents:
_____ period for children and adolescents versus ____ period for adults

A

1 year; 2 year

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21
Q

BP-I vs. BP-II vs. Cyclothymia
Specifier-All
With _______ distress

A

anxious

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22
Q

BP-I vs. BP-II vs. Cyclothymia
Severity Specifiers:
BP-I and BP-II
Severity ______, ______, ______, or with _______

A

mild, moderate, severe, or with psychotic features

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23
Q

BP-I vs. BP-II vs. Cyclothymia
Course Specifiers:
BP-I and BP-II
______ or _______ remission

A

Full or partial remission

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24
Q 
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\_\_\_\_\_ \_\_\_\_\_
A
  1. features
  2. cycling
  3. mood-congruent; mood-incongruent
  4. catatonia
  5. peripartum onset
  6. seasonal pattern
  7. melancholic features
  8. atypical features
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25
Q

BP-I vs. BP-II vs. Cyclothymia

All cannot be attributable to _______

A

substance

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26
Q

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 ______

A
  1. dysphoria; depressed
  2. anhedonia
  3. retardation
  4. loss of energy
  5. worthless; guilt
  6. death, suicidal ideation, plan, or attempt
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27
Q

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 ______

A
  1. expansive
  2. self-esteem; grandiosity
  3. talkativeness; speech
  4. ideas; racing
  5. directed activity
  6. pleasurable; high
  7. sleep
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28
Q

Mixed Features Specifier for Bipolar:

If criteria met for full episode of mania and depression simultaneously then Dx……

A

Manic Episode with Mixed Features

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29
Q

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 _________

A
  1. 4; 12
  2. Full or partial; 2; polarity
  3. not counted
  4. the same pole
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30
Q 
With Psychotic Features Specifier:
Mood Congruent = themes of:
1. 
2. 
3.
A
  1. grandiosity
  2. invulnerability
  3. paranoia - especially doubts about other’s capabilities
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31
Q

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

A

1; 2 (manic/hypomanic or depressed)

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32
Q

Differential Dx
Worse in BP-I, BP-II, or Unipolar:
Impairment: Impairment level can be ________

A

similar across all types

33
Q

Differential Dx
Worse in BP-I, BP-II, or Unipolar:
Suicide attempts:
_____ data if any ______ in one BP subtype than the other

A

Mixed; higher

34
Q

Differential Dx
Worse in BP-I, BP-II, or Unipolar:
Psychosis:
Highest in ______

A

BP-I

35
Q

Differential Dx
BP-I and BP-II
More _______ agitation in their depression than unipolar

A

psychomotor

36
Q

Differential Dx
BP-I and BP-II
Depression _____ in morning and more early morning awakenings than unipolar

A

worst

37
Q

Differential Dx
BP-I and BP-II
Greater ________ concentrating than unipolar

A

difficulty

38
Q

Bipolar prevalence

A

~ 1%

39
Q

Bipolar onset

A

Avg is 18-20 y.o.

20% of cases onside is less than 13 years

40
Q

Bipolar sex ratio:

In children

A

Males > Females

41
Q

Bipolar sex ratio:

In adults

A

Males = Females

42
Q

Bipolar comorbidity:
1.
2.
3.

A
  1. Anxiety Dxs
  2. Substance Dxs
  3. Borderline PD
43
Q

Bipolar Suicidality:

_____ higher in BP than general population

A

14x

44
Q

Bipolar: Depressive/Manic Balance:

For majority of cases the number of depressive episodes ____ than the number of manic/hypomanic episodes

A

is greater

45
Q

Kindling

A

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

46
Q

Bipolar genetics

High or low heritability?

A

High heritability rate

.85 to .93

47
Q

Bipolar neurotransmitters involved

A

Dopamine

Serotonin

48
Q

Med Tx for Bipolar:

Lithium side effects

A

Toxic range is next to therapeutic range

Hand tremors, weight gain, thirst

49
Q

Med Tx for Bipolar:
AEDs Anti-epileptic drugs
Side effects

A

Potential teratogens

Stevens-Johnson Syndrome

50
Q

Meds - Acute Mania

Lithium is ______ at addressing mania than antipsychotic meds and there is ______ between among AEDs and Li.

A

slower; no noteworthy difference

51
Q

Meds - Depressive phase

Antipsychotics
1.

AEDs
2.

A
  1. Latuda

2. Lamictal

52
Q

Meds - Prophylactic/Maintenance:
Lithium is an ______
Especially in preventing _______ phase.

Lamictal has prophylactic efficacy for the ______ pole and may be better for _______

A

effective prophylaxis agent; manic; depressive; BP-II

53
Q 
Psychotherapy Tx:
Acute phase: 
Very limited evidence to support use of:
1. 
2.
3.
A
  1. CBT
  2. Interpersonal
  3. Social Rhythm
54
Q 
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 \_\_\_\_\_\_\_
A
  1. relapse
  2. overall functioning
  3. medication
  4. regular habits
  5. planning; deteriorating
55
Q

Peds BP:

Irritability is ______ found in Peds BP

A

frequently

56
Q

Peds BP:
Irritability is not unique to Peds BP.
What other Dxs can express irritability?
Name 6

A 
MDD
Persistent Depressive Dx
Generalized Anxiety Dx
PTSD
Oppositional Defiant Dx
Disruptive Mood Dysregulation Dx
57
Q

Peds BP:
Popularity of Dx
~ 60% of medical visits where the child received this Dx outpatient the Tx was….

A

polypharmacy

58
Q

Peds BP:

~ 48% of those visits the Tx included an _______

A

atypical antipsychotic

59
Q

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 ______

A

1997 and 2004

438%; 296%; 17%

60
Q

Peds BP:
Narrow Phenotype

Follows DSM-5
OR
More _____ - Requires “______” Sx of _______ mood and/or _______

A

rigorous; “cardinal”; elated mood; grandiosity

61
Q

Peds BP:
Broad Phenotype

Ultra-______ rapid _____

Comorbid _______

Rageful _______

Ir______

A

ultra; cycling

ADHD

reactions

Irritability

62
Q

Peds BP:
DSM-5’s Solution

Disruptive Mood Dysregulation Dx is created to __________

A

decrease incidence of BP in youth

63
Q

Peds BP:
DSM-5’s Solution
Placed with unipolar because DSM says….

A

irritability associated with later unipolar (not BP)

64
Q

DMDD Diagnostics:
A. Severe, recurrent _______ _____, manifested verbally and/or ______ that are ______ out of proportion in _____ or ______ to the situation or _________

A

temper outbursts; behaviorally; grossly; intensity; duration; provocation

65
Q

DMDD Diagnostics:

B. Outbursts are _______ with _______ level

A

inconsistent; developmental

66
Q

DMDD Diagnostics:

C. Outbursts occur more than _______ times per week (average)

A

3 times per week

67
Q

DMDD Diagnostics:
D. The _____ between outbursts is persistently _______ or ______ most of the day, nearly ______ day, and observable ________

A

mood; irritable; angry; every; by others

68
Q

DMDD Diagnostics:
E. Criteria _____- _____ present more than _____ months with no period more than ______ months without all ______ in Criteria A-D

A

A-D; 12 months; 3 months; symptoms

69
Q

DMDD Diagnostics:

F. Do not make diagnosis for 1st time before _____ and after ______.

A

age of 6; after age of 18

70
Q

DMDD Diagnostics:

G. (By Hx or observation) age of onset for criteria A-E is less than _____ years

A

10

71
Q

DMDD Diagnostics:

H. _____ been a distinct period of more than ____ where they met full Sx criteria for _____ or _______

A

Never; 1 day; mania or hypomania

72
Q

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)

A

Behaviors; MDD

73
Q

DMDD Diagnostics:

J. Not attributable to _____ or other ______

A

substance; medical condition

74
Q

DMDD
Comorbidity:
If could Dx with ODD then those with DMDD would be at 54 to 103x greater risk of having…

A

ODD

75
Q

DMDD
Comorbidity:
ICD made DMDD a specifier of _____ for those with chronic _____

A

ODD; irritability

76
Q

DMDD
Course:
Only ______ maintained a Dx 2-3 years later

A

14-19%

77
Q

DMDD
Genetics:
Offspring whose parents had ______ are 5.4x more likely to have DMDD

A

BP

78
Q

DMDD
Tx:
1. Parent ______
2. IPT - for ____ and _____

A
  1. training

2. for mood and dysregulation

Adv. Psychopathology Midterm (5 decks)

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