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MRCPSYCH_Paper B_MENTOR & More_Dr. ART > Bipolar - 2 > Flashcards

Bipolar - 2 Flashcards

1
Q

What is rapid cycling

A

A qualifier [not subtype] for BI, II and MDD

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2
Q

criterias for Rapid cycling

A

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

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3
Q

Are inrervetion any different for rapid cycling

A

No (Nice)

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4
Q

Prevalence of rapid cycling in patiets with bipolar

A

10-20%

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5
Q

When does Rapid cycling usually occurs in the course of bipolar

A

Late stage

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6
Q

How long rapid cycling last?

A

Less than 2 years in 50%

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7
Q

Comapred to non rapid one, Rapid cycling is…

A

More in females
Younger onset
Greater burden
Rx resistant

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8
Q

Potential precipitant factors for rapid cycling

A

Medical disorder
Medications
Life events
Alcohol abuse
Antidepressants

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9
Q

Medical disorders associated with Rapid cycling

A

Hypothyroid
Grave’s disease
Stroke
TBI
MS
subarachnoid haemorrhage

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10
Q

drugs associated with (potential) rapid cycling

A

Propranolol
Levadopa
Cyproheptadin

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11
Q

Types of bipolar in dsm 5

A

I
II
cyclothymic disorder

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12
Q

What is cyclothymic disorder dsm 5

A

numerous periods of subthreshold hypomanic and depressive episodes over 2 years

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13
Q

Criteria for Bipolar I in dsm 5

A

At least one manic episode within lifetime
3 of qualifier symptoms

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14
Q

What is a manic episode definition in dsm 5

A

*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.

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15
Q

What are qualifier symptoms

A

Grandiosity
Flight of idea
dec. need for sleep
talkativeness
distractibility
inc. goal directed activities
engage in potentially harmful activities

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16
Q

When bipolar i criteria require 4, not three qualifiers?

A

When irritability is predominant mood

17
Q

Is major depressive episode required for bipolar I in dms 5?

A

Nope

18
Q

Difference in bipolar II criteria dsm 5 compared to bipolar I?

A

At least One hyponamic episode (past or present)
At least one depressive episode
At least for 4 days

(rest is the same)

19
Q

When can a women under 55 be put on valproate in bipolar ?

A

Only if rwo specialist independenty confirmed the necessity

20
Q

What should you do for a childbearing lady who is put on valproate (justifiably)?

A

Must be enrolled in pregnancy prevention plan (MHRA)

21
Q

can a father on valproate at conception increase risk of harm to child?

A

yes, small but yes!

Use proper contraception

22
Q

line 1 - A patient with manic episode comes who is on antidepressant what Nice recommends?

A

consider stoping the antidepressant and offer an antipsychotic regardless of antidepressant stopping decision

23
Q

Step 2 - A patient with manic episode comes who is not on antipsychotics or mood stabilizers, what Nice recommends?

A

Offer either one of

Haloperidol
Quetiapine
Olanzapine
Risperidone

24
Q

Line 3- A patient with manic episode comes who is taking lithium what Nice recommends?

A

Check Lithium Plasma level

consider adding one of Halo,Ris,Que or Olan antipsychotics as in line 2

25
Q

Line 4- A patient with manic episode comes who is on lithium, you added an antipsychotic but did not respond, what Nice recommends?

A

Offer an alternate on the list

26
Q

Line 5- A patient with manic episode comes you try antipsychotics with max dose, but dont work, what Nice recommends?

A

Add lithium

27
Q

Line 3- A patient with manic episode comes in, antipsychotic and lithium trial did not work, what Nice recommends?

A

Consider valproate

28
Q

Line 6- A patient with manic episode comes who is on valproate or another mood stablizer up to max dose, what Nice recommends?

A

Add antipsychotics (halo,olan, que, ris)

29
Q

An acronym for antipsychotics in bipolar

A

HOQR

Halt Overactive Quicks Rapidly

Halo
Olan
Que
Risper

30
Q

What mood stabilizer should not be given to treat mania?

A

Lamotrigine

31
Q

Line 7- A patient with manic episode comes who did not show any response any line of treatment mentioned before what Nice recommends?

A

E C T

32
Q

Long Term Rx in mania

A

1st = psychological intervention
2nd = 1st pharma = lithium
3rd = if lithium ineffective = antipsychotics HOQR
4th = if antipsychotic fail = try valproate + antipsychotic/ lithium

MRCPSYCH_Paper B_MENTOR & More_Dr. ART (69 decks)

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