Bipolar

Question 1

do you need to have had periods of depression for bipolar type I?

Answer 1

No, only need to have had a manic episode

Question 2

what is the most severe bipolar disorder?

Answer 2

Bipolar I

Question 3

A. a distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week (or any duration if hospitalization necessary) with 3 or more symptoms

Answer 3

Manic episode

Question 4

what are the symptoms of mania

Answer 4

inflated self-esteem or grandiosity
decreased need for sleep
talkativeness
flight of ideas or racing thoughts
distractibility
increase in goal direct activity or psychomotor agitation
excessive involvement in pleasurable activities w/ a high potential for painful consequences

Question 5

bipolar episode with a manic episode where they are thinking about suicide.

Answer 5

Mixed episode

Question 6

Presence or history of at least one Major Depressive episode
Presence or history of at least one hypomanic episode
Never been a manic nor Mixed episode

Answer 6

Bipolar Type II

Question 7

Tend to be people who have been treated for MDD but aren’t responding to medical tx.

Answer 7

Bipolar Type II

Question 8

Very similar to manic symptoms but need only 4 days duration, and severity is less than during a manic episode.
Also, no psychotic features
There is a change in functioning, but not as severe as in a manic episode, and it is noticeable by others.

Answer 8

Hypomanic episode

Question 9

Like dysthymic disorder, except that there are numerous symptoms of depression AND hypomania without meeting criteria for a Major depressive episode nor a hypomanic episode.

Answer 9

CYCLOTHYMIC EPISODE

Question 10

Very rapid alteration over days between manic symptoms od depressive symptoms without meeting criteria for manic episode nor a major depressive episode

Answer 10

bipolar disorder NOS

Question 11

When you cannot determine if it is in the depressive spectrum only or a bipolar spectrum disorder.
Try not to use this, but we often do in children and adolescents when the clinical picture can be quite varied.

Answer 11

Mood Disorder NOS

Question 12

What is the median onset for bipolar disorder?

Answer 12

25

Question 13

Gold standard treatment—first line treatment, an be used with other treatments too.

Answer 13

Lithium

Question 14

what is the first sign of lithium toxicity?

Answer 14

ataxia

Question 15

what are other ADRs of lithium

Answer 15

renal toxicity
thyrotoxic
tremor, nausea, increased urination, weight gain

Question 16

when do you measure a trough level for steady state for lithium

Answer 16

measure trough level for steady state after 5 days

Question 17

Second line treatment—no more effective than Lithium

Black box warning of risk of acute pancreatitis

Answer 17

Valproic Acid (Depakote)

Question 18

when are blood draws needed after valproic acid initiation?

Answer 18

7 days after dosing

Question 19

ADRs w/ valproic acid

Answer 19

GI upset, liver toxic, hair loss, acne, weight gain.

PCOS w/ teen girls

Question 20

what birth defects can be caused w/ valproic acid?

Answer 20

spina bifida

Question 21

Good medicine for Bipolar Type II. Titrate dose up to decrease risk of Steven Johnson’s. Not as good for mania, better for depression

Answer 21

Lamotrigine

Question 22

What drug can’t be mixed w/ lamotrigine?

Answer 22

lamictal

Question 23

if the patient has stopped taking lamotrigine what must happen?

Answer 23

titrate dose back up

Question 24

a lot of people with bipolar disorders will be on what in addition to a mood stabilizer?

Answer 24

atypical antipsychotic

Question 25

when is suicide risk high w/ bipolar patients?

Answer 25

during mania

Question 26

when may benzos be helpful

Answer 26

short term setting to help w/ mania