Bipolar 2 Flashcards
Alertness during manic episode (mental status)
Normal unless sleep deprived
(alertness and orientation will be the only “normal” findings)
Mental status finding: orientation during manic episode
normal unless psychotic
Mental status finding: motor activity manic episode
Restless or agitated
Mental status finding: appearance during manic episode
Dramatic
Mental status finding: speech during manic episode
Often pressured
Mental status finding: affect during manic episode
Labile or seductive
Mental status finding: mood during manic episode
Elevated or irritable
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)
Mental status finding: thought content during manic episode
- Paranoid or grandiose
- Delusions
- Hallucinations
Mental status finding: attention during manic episode
Distractible
Mental status finding: memory during manic episode
May be impaired
Mental status finding: judgment during manic episode
May be impaired
(insight as well)
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)
_____% of people the single manic episode will have another episode
90
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)
_____% do bipolar patients who experience chronic interpersonal or occupational difficulties
60
Maternal ________ may be one cause of bipolar disorder.
Maternal infection w/the flu
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
- Number of episodes time spent ill
- Postpartum episodes more likely
- Antidepressant Associated cycle induction / acceleration
Effects of substance abuse and bipolar disorder (4)
(60% demonstrate substance abuse)
- Earlier onset of bipolar
- Rapid Cycling in mixed states
- Slower remission for mania
- Medication resistance (may lead to suicide)
Causes of bipolar mood syndromes
- Drugs: Isoniazid, steroids, disulfiram
- Neurologic Factors: Multiple sclerosis, closed head injury, CNS tumors, epilepsy, Huntington’s disease, cerebrovascular accident, dementia
- Metabolic factors: Thyroid disorders, postoperative states, adrenal disorders, vitamin B12 deficiency, electrolyte abnormality
- Infection: AIDS dementia, neurosyphyllis, influenza
Inclusive diagnostic criteria for cyclothymic disorder
- 2 years, numerous periods w/ hypomanic sx and depressive sx that do not meet criteria for a MDD
- Not been without symptoms for more than 2 months at a time
- Cause significant distress or impairment
Exclusive diagnostic criteria for cyclothymic disorder (3).
- No MDD, Manic Or Mixed Episodes
- Sx not better explained by other psychiatric illness
- Not caused by a substance
Acute Mania: treatment (4)
- Agressive somatic therapies
- Hospitalization
- Monitor closely for subsequent depressive episode emergence
- Give family psychological and educational support
Severe manic or mixed episodes: First-line acute treatment options
- Divalproex & atypical antipsychotic
- Lithium & atypical antipsychotic (olanzapine or risperidone)
- +/- short-term benzodiazepine
Severe manic or mixed episodes: acute second-line treatment
- Carbamazepine or oxcarbamazepine
- Ziprasidone or quetiapine
Mood stabilizing medications: treatment of acute Mania
- FDA-approved: lithium, carbamazepine, divalproex
- Other: oxcarbamazepine
Treatment of acute Mania: tranquilizers
- clonazepam
- lorazepam
(no FDA-approved)
Bipolar depression: acute first-line treatment
- Lithium
- Antidepressant
- Psychotic depressions → adjunctive antipsychotics
- ECT if life-threatening, treatment-resistant, psychotic or catatonic
Bipolar depression: second-line acute treatment
- Lamotrigine as alternative first-line treatment
- Add interpersonal or cognitive therapy to medication
- Augment w/ bupropion, paroxetine, venlafaxine other SSRIs, or an MAOI for breakthrough depression
- Antidepressants recommended earlier for II
Acute bipolar depression: mood-stabilizing medication
- FDA: lithium
- lamotrigine
(everything is compared to lithium for efficacy)
Acute depression : antipsychotic treatment (5)
- olanzapine/fluoxetine combination
- uetiapine
- cariprazine
- lurasidone
- Other atypicals
Bipolar mood stabilizers (5)
- Lithium carbonate
- Lamotrigine
- Carbamazepine
- Oxcarbamazepine
- Valproate
Drugs that may be an organic cause of bipolar mood syndromes
- Isoniazid
- steroids
- disulfiram
Neurologic Factors that may be an organic cause of bipolar mood syndromes:
- Multiple sclerosis
- closed head injury
- CNS tumors
- epilepsy
- Huntington’s disease
- cerebrovascular accident
- dementia
Metabolic factors that may be a cause of bipolar mood syndrome: (5)
- Thyroid disorders
- Adrenal disorders
- Vitamin B12 deficiency
- Electrolyte abnormality
- Postoperative states
Infection that may be an organic cause of bipolar mood disorder: (3)
- AIDS dementia
- Neurosyphyllis
- Influenza (also if mother was infected while pregnant)
When differentiating between bipolar & ADHD, bipolar will exhibit more _______ (5).
- Grandiosity
- Daredevil acts
- Elevated mood
- Silly / laughing
- Uninhibited people seeking
