Bipolar 2 Flashcards by K Medina

Alertness during manic episode (mental status)

Normal unless sleep deprived

(alertness and orientation will be the only “normal” findings)

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Mental status finding: orientation during manic episode

normal unless psychotic

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Mental status finding: motor activity manic episode

Restless or agitated

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Mental status finding: appearance during manic episode

Dramatic

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Mental status finding: speech during manic episode

Often pressured

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Mental status finding: affect during manic episode

Labile or seductive

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Mental status finding: mood during manic episode

Elevated or irritable

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Mental status finding: thought process during manic episode

Tangential or loose associations/flight of ideas
Clang associations (ex: “Slagle, bagel, fagel!”)

(Thought Content: May have paranoid or grandiose delusions or hallucinations)

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Mental status finding: thought content during manic episode

Paranoid or grandiose
Delusions
Hallucinations

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Mental status finding: attention during manic episode

Distractible

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Mental status finding: memory during manic episode

May be impaired

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Mental status finding: judgment during manic episode

May be impaired

(insight as well)

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The key feature defining bipolar from schizophrenia

Psychosis: looking for cycling

(Core symptoms of bipolar disorder are about mood; Psychosis is secondary. Schizophrenia is about psychosis)

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_____% of people the single manic episode will have another episode

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On average a patient with bipolar disorder will have 4 episodes every _____.

10 years

(they should remain on medication even though they haven’t had an episode four years. The effects of mania and depression can be devastating)

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_____% do bipolar patients who experience chronic interpersonal or occupational difficulties

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Maternal ________ may be one cause of bipolar disorder.

Maternal infection w/the flu

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Once bipolar is diagnosed the patient will spend_____without symptoms

half of their life

(2/3 in depressed episode, this is when you will see them)

You are most likely to see a bipolar patient during ________.

In depressive episode - 3.5 fold more frequent than mania

(bipolar 2 it is even more likely to be depressed)

Bipolar disorder: differential diagnosis

Schizophrenia/schizoaffective disorder
Major depressive disorder
Anxiety disorder
Substance use disorder
Borderline personality disorder
Attention deficit hyperactivity disorder

Unipolar (depression) patients typically exhibit _______ (2), while bipolar patients exhibit more _____(2).

Unipolar: crave sugar (gain weight),
Bipolar: more psychosis, psychomotor retardation

Differences in treatment response between unipolar and bipolar

Bipolar will have:

Hx of treatment failure
Non-responsive erratic response to antidepressants

Behaviors that might be a clue to bipolar diagnosis (3).

Unevenness in Intimate Relationships
Frequent career changes
Substance use disorder

(mn: “Someone who has had three marriages, three separate careers and has failed three separate antidepressants are probably bipolar.”)

Age of onset is earlier in ______ (bipolar / unipolar depression)

Bipolar

Course of symptoms that are ***_greater_*** in bipolar than unipolar depression

1. Number of episodes time spent ill 2. Postpartum episodes more likely 3. Antidepressant Associated cycle induction / acceleration

Effects of substance abuse and bipolar disorder (4) (60% demonstrate substance abuse)

1. Earlier onset of bipolar 2. Rapid Cycling in mixed states 3. Slower remission for mania 4. Medication resistance (may lead to suicide)

Causes of bipolar mood syndromes

1. **Drugs**: Isoniazid, steroids, disulfiram 2. **Neurologic Factors**: Multiple sclerosis, closed head injury, CNS tumors, epilepsy, Huntington’s disease, cerebrovascular accident, dementia 3. **Metabolic factor**s: Thyroid disorders, postoperative states, adrenal disorders, vitamin B12 deficiency, electrolyte abnormality 4. **Infection**: AIDS dementia, neurosyphyllis, influenza

Inclusive diagnostic criteria for cyclothymic disorder

1. 2 years, numerous periods w/ hypomanic sx and depressive sx that do not meet criteria for a MDD 2. Not been without symptoms for more than 2 months at a time 3. Cause significant distress or impairment

Exclusive diagnostic criteria for cyclothymic disorder (3).

1. No MDD, Manic Or Mixed Episodes 2. Sx not better explained by other psychiatric illness 3. Not caused by a substance

Acute Mania: treatment (4)

1. Agressive somatic therapies 2. Hospitalization 3. Monitor closely for subsequent depressive episode emergence 4. Give family psychological and educational support

Severe manic or mixed episodes: First-line acute treatment options

1. Divalproex & atypical antipsychotic 2. Lithium & atypical antipsychotic (olanzapine or risperidone) 3. +/- short-term benzodiazepine

Severe manic or mixed episodes: acute second-line treatment

1. Carbamazepine or oxcarbamazepine 2. Ziprasidone or quetiapine

Mood stabilizing medications: treatment of acute Mania

* FDA-approved: lithium, carbamazepine, divalproex * Other: oxcarbamazepine

Treatment of acute Mania: tranquilizers

* clon**azepam** * lor**azepam** (no FDA-approved)

Bipolar **depression**: acute first-line treatment

1. Lithium 2. Antidepressant 3. Psychotic depressions → adjunctive antipsychotics 4. ECT if life-threatening, treatment-resistant, psychotic or catatonic

Bipolar **depression**: second-line acute treatment

1. **Lamotrigine** as alternative first-line treatment 2. Add interpersonal or cognitive **therapy** to medication 3. Augment w/ **bupropion, paroxetine,** **venlafaxine other SSRIs, or an MAOI** for breakthrough depression 4. **Antidepressants** recommended earlier for II

Acute bipolar depression: mood-stabilizing medication

1. FDA: lithium 2. lamotrigine ## Footnote ***_(everything is compared to lithium for efficacy)_***

Acute depression : antipsychotic treatment (5)

1. olanzapine/fluoxetine combination 2. uetiapine 3. cariprazine 4. lurasidone 5. Other atypicals

Bipolar mood stabilizers (5)

1. Lithium carbonate 2. Lamotrigine 3. Carbamazepine 4. Oxcarbamazepine 5. Valproate

Drugs that may be an organic cause of bipolar mood syndromes

1. Isoniazid 2. steroids 3. disulfiram

Neurologic Factors that may be an organic cause of bipolar mood syndromes:

1. Multiple sclerosis 2. closed head injury 3. CNS tumors 4. epilepsy 5. Huntington’s disease 6. cerebrovascular accident 7. dementia

Metabolic factors that may be a cause of bipolar mood syndrome: (5)

1. Thyroid disorders 2. Adrenal disorders 3. Vitamin B12 deficiency 4. Electrolyte abnormality 5. Postoperative states

Infection that may be an organic cause of bipolar mood disorder: (3)

1. AIDS dementia 2. Neurosyphyllis 3. Influenza (also if mother was infected while pregnant)

When differentiating between bipolar & ADHD, bipolar will exhibit more _______ (5).

1. Grandiosity 2. Daredevil acts 3. Elevated mood 4. Silly / laughing 5. Uninhibited people seeking