bipolar

Question 1

Bipolar I & II DSM-5 criteria?

Answer 1

Bipolar I: MUST have an episode of mania. they may have interspersed MDE, hypomania, or euthymia between manic episodes but its not required for diagnosis

Bipolar II: At least one hypomanic episode and one MDE. If ever there is mania, its bipolar I regardless

Question 2

Bipolar I
lifetime prevalence?
female vs male? vs bipolar II?
onset at which year?
if left untreated?
course and overall prognosis?
suicide rates?

Answer 2

1-2%
equal. female more than males
before 30s
it will last several months
course is chronic with relapses
50% attempt and 15% succeed

Question 3

pharmacotherapy? what to check?

psychotherapy?

ECT?

Answer 3

mood stabilizers (lithium, valproate acid, carbamazepine). antidepressants only given for depressive episodes along with mood stabilizers if needed and NEVER as monotherapy as it can trigger manic episodes.

Cogntive therapy, interpersonal therapy

ECT great for pregnant women, refractory or life-threatening acute mania or depression. decreases suicide risk

Question 4

prognosis for woman with mania while pregnant?

Answer 4

high rate of relapse in following pregnancy. give mood stabilizers as prophylaxis

Question 5

rapid cycling?

melancholic features?

atypical features?

Answer 5

4 or more mood episodes in one year

early morning awakening, anhedonia, anxiety, depression worse in mornings, excessive guilt

leaden paralysis, mood reactivity, hypersensitive to interpersonal rejection, hypersomnia

Question 6

psychotic features?

catatonia?

peripartum onset?

seasonal pattern?

Answer 6

delusions or hallucinations occuring only during mood episodes not interspersed?

catalepsy, mutism, negativism, bizarre uncomfortable posture, purposeless motor activities, echolalia

manic or hypomanic episodes during pregnancy or 4 weeks after delivery

temporal relationship between mania/hypomania and particular time of year