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Behavioral Medicine > Bipolar 2 > Flashcards

Bipolar 2 Flashcards

1
Q

Alertness during manic episode (mental status)

A

Normal unless sleep deprived

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

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2
Q

Mental status finding: orientation during manic episode

A

normal unless psychotic

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3
Q

Mental status finding: motor activity manic episode

A

Restless or agitated

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4
Q

Mental status finding: appearance during manic episode

A

Dramatic

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5
Q

Mental status finding: speech during manic episode

A

Often pressured

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6
Q

Mental status finding: affect during manic episode

A

Labile or seductive

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7
Q

Mental status finding: mood during manic episode

A

Elevated or irritable

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8
Q

Mental status finding: thought process during manic episode

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

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

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9
Q

Mental status finding: thought content during manic episode

A
  1. Paranoid or grandiose
  2. Delusions
  3. Hallucinations
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10
Q

Mental status finding: attention during manic episode

A

Distractible

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11
Q

Mental status finding: memory during manic episode

A

May be impaired

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12
Q

Mental status finding: judgment during manic episode

A

May be impaired

(insight as well)

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13
Q

The key feature defining bipolar from schizophrenia

A

Psychosis: looking for cycling

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

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14
Q

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

A

90

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15
Q

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

A

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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16
Q

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

A

60

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17
Q

Maternal ________ may be one cause of bipolar disorder.

A

Maternal infection w/the flu

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18
Q

Once bipolar is diagnosed the patient will spend_____without symptoms

A

half of their life

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

19
Q

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

A

In depressive episode - 3.5 fold more frequent than mania

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

20
Q

Bipolar disorder: differential diagnosis

A
  1. Schizophrenia/schizoaffective disorder
  2. Major depressive disorder
  3. Anxiety disorder
  4. Substance use disorder
  5. Borderline personality disorder
  6. Attention deficit hyperactivity disorder
21
Q

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

A
  • Unipolar: crave sugar (gain weight),
  • Bipolar: more psychosis, psychomotor retardation
22
Q

Differences in treatment response between unipolar and bipolar

A

Bipolar will have:

  1. Hx of treatment failure
  2. Non-responsive erratic response to antidepressants
23
Q

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

A
  1. Unevenness in Intimate Relationships
  2. Frequent career changes
  3. Substance use disorder

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

24
Q

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

A

Bipolar

25
Q

Course of symptoms that are greater in bipolar than unipolar depression

A
  1. Number of episodes time spent ill
  2. Postpartum episodes more likely
  3. Antidepressant Associated cycle induction / acceleration
26
Q

Effects of substance abuse and bipolar disorder (4)

(60% demonstrate substance abuse)

A
  1. Earlier onset of bipolar
  2. Rapid Cycling in mixed states
  3. Slower remission for mania
  4. Medication resistance (may lead to suicide)
27
Q

Causes of bipolar mood syndromes

A
  1. Drugs: Isoniazid, steroids, disulfiram
  2. Neurologic Factors: Multiple sclerosis, closed head injury, CNS tumors, epilepsy, Huntington’s disease, cerebrovascular accident, dementia
  3. Metabolic factors: Thyroid disorders, postoperative states, adrenal disorders, vitamin B12 deficiency, electrolyte abnormality
  4. Infection: AIDS dementia, neurosyphyllis, influenza
28
Q

Inclusive diagnostic criteria for cyclothymic disorder

A
  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
29
Q

Exclusive diagnostic criteria for cyclothymic disorder (3).

A
  1. No MDD, Manic Or Mixed Episodes
  2. Sx not better explained by other psychiatric illness
  3. Not caused by a substance
30
Q

Acute Mania: treatment (4)

A
  1. Agressive somatic therapies
  2. Hospitalization
  3. Monitor closely for subsequent depressive episode emergence
  4. Give family psychological and educational support
31
Q

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

A
  1. Divalproex & atypical antipsychotic
  2. Lithium & atypical antipsychotic (olanzapine or risperidone)
  3. +/- short-term benzodiazepine
32
Q

Severe manic or mixed episodes: acute second-line treatment

A
  1. Carbamazepine or oxcarbamazepine
  2. Ziprasidone or quetiapine
33
Q

Mood stabilizing medications: treatment of acute Mania

A
  • FDA-approved: lithium, carbamazepine, divalproex
  • Other: oxcarbamazepine
34
Q

Treatment of acute Mania: tranquilizers

A
  • clonazepam
  • lorazepam

(no FDA-approved)

35
Q

Bipolar depression: acute first-line treatment

A
  1. Lithium
  2. Antidepressant
  3. Psychotic depressions → adjunctive antipsychotics
  4. ECT if life-threatening, treatment-resistant, psychotic or catatonic
36
Q

Bipolar depression: second-line acute treatment

A
  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
37
Q

Acute bipolar depression: mood-stabilizing medication

A
  1. FDA: lithium
  2. lamotrigine

(everything is compared to lithium for efficacy)

38
Q

Acute depression : antipsychotic treatment (5)

A
  1. olanzapine/fluoxetine combination
  2. uetiapine
  3. cariprazine
  4. lurasidone
  5. Other atypicals
39
Q

Bipolar mood stabilizers (5)

A
  1. Lithium carbonate
  2. Lamotrigine
  3. Carbamazepine
  4. Oxcarbamazepine
  5. Valproate
40
Q

Drugs that may be an organic cause of bipolar mood syndromes

A
  1. Isoniazid
  2. steroids
  3. disulfiram
41
Q

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

A
  1. Multiple sclerosis
  2. closed head injury
  3. CNS tumors
  4. epilepsy
  5. Huntington’s disease
  6. cerebrovascular accident
  7. dementia
42
Q

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

A
  1. Thyroid disorders
  2. Adrenal disorders
  3. Vitamin B12 deficiency
  4. Electrolyte abnormality
  5. Postoperative states
43
Q

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

A
  1. AIDS dementia
  2. Neurosyphyllis
  3. Influenza (also if mother was infected while pregnant)
44
Q

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

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

Behavioral Medicine (35 decks)

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