Bipolar - 2 Flashcards
What is rapid cycling
A qualifier [not subtype] for BI, II and MDD
criterias for Rapid cycling
At least 4 episodes in past 12 months
Episodes are separated by partial or full remissionbfor at least 2 months OR Or
by a switch to opposite polarity
Are inrervetion any different for rapid cycling
No (Nice)
Prevalence of rapid cycling in patiets with bipolar
10-20%
When does Rapid cycling usually occurs in the course of bipolar
Late stage
How long rapid cycling last?
Less than 2 years in 50%
Comapred to non rapid one, Rapid cycling is…
More in females
Younger onset
Greater burden
Rx resistant
Potential precipitant factors for rapid cycling
Medical disorder
Medications
Life events
Alcohol abuse
Antidepressants
Medical disorders associated with Rapid cycling
Hypothyroid
Grave’s disease
Stroke
TBI
MS
subarachnoid haemorrhage
drugs associated with (potential) rapid cycling
Propranolol
Levadopa
Cyproheptadin
Types of bipolar in dsm 5
I
II
cyclothymic disorder
What is cyclothymic disorder dsm 5
numerous periods of subthreshold hypomanic and depressive episodes over 2 years
Criteria for Bipolar I in dsm 5
At least one manic episode within lifetime
3 of qualifier symptoms
What is a manic episode definition in dsm 5
*Distince period of abnormally, persistently elevated, expansive or irritable mood
*Inc. goal directed activity or energy
*lasting at least 7 days
*all day, nearly everyday
*or any duration if hospiralization was required.
What are qualifier symptoms
Grandiosity
Flight of idea
dec. need for sleep
talkativeness
distractibility
inc. goal directed activities
engage in potentially harmful activities
When bipolar i criteria require 4, not three qualifiers?
When irritability is predominant mood
Is major depressive episode required for bipolar I in dms 5?
Nope
Difference in bipolar II criteria dsm 5 compared to bipolar I?
At least One hyponamic episode (past or present)
At least one depressive episode
At least for 4 days
(rest is the same)
When can a women under 55 be put on valproate in bipolar ?
Only if rwo specialist independenty confirmed the necessity
What should you do for a childbearing lady who is put on valproate (justifiably)?
Must be enrolled in pregnancy prevention plan (MHRA)
can a father on valproate at conception increase risk of harm to child?
yes, small but yes!
Use proper contraception
line 1 - A patient with manic episode comes who is on antidepressant what Nice recommends?
consider stoping the antidepressant and offer an antipsychotic regardless of antidepressant stopping decision
Step 2 - A patient with manic episode comes who is not on antipsychotics or mood stabilizers, what Nice recommends?
Offer either one of
Haloperidol
Quetiapine
Olanzapine
Risperidone
Line 3- A patient with manic episode comes who is taking lithium what Nice recommends?
Check Lithium Plasma level
consider adding one of Halo,Ris,Que or Olan antipsychotics as in line 2
Line 4- A patient with manic episode comes who is on lithium, you added an antipsychotic but did not respond, what Nice recommends?
Offer an alternate on the list
Line 5- A patient with manic episode comes you try antipsychotics with max dose, but dont work, what Nice recommends?
Add lithium
Line 3- A patient with manic episode comes in, antipsychotic and lithium trial did not work, what Nice recommends?
Consider valproate
Line 6- A patient with manic episode comes who is on valproate or another mood stablizer up to max dose, what Nice recommends?
Add antipsychotics (halo,olan, que, ris)
An acronym for antipsychotics in bipolar
HOQR
Halt Overactive Quicks Rapidly
Halo
Olan
Que
Risper
What mood stabilizer should not be given to treat mania?
Lamotrigine
Line 7- A patient with manic episode comes who did not show any response any line of treatment mentioned before what Nice recommends?
E C T
Long Term Rx in mania
1st = psychological intervention
2nd = 1st pharma = lithium
3rd = if lithium ineffective = antipsychotics HOQR
4th = if antipsychotic fail = try valproate + antipsychotic/ lithium
