bipolar Flashcards
in order to be qualified as mania
distinct, abnormal, elevated, expansive (or irritable mood) X 7 days minimum
in order to be qualified as mania at least what 3 symptoms must be present for at least 2 weeks?
- increased self esteem/grandiosity
- decreased sleep
- increased speech
- racing thoughts
- distractibility
- increased activity (and energy is key for DSM5)
- increased dangerous impulsivity
DTRHIGH
Distractible Talkative Racing thoughts Hyperactive Impulsive Grandiose Hyposomnic
what is hypomania?
- milder mania
- at least 4 days or more
- same symptoms as mania
- the symptoms provide an unequivocal change in function, personality… that is clearly noted by others
- not severe enough to cause marked impairment
what is major depressive episode?
pervasive sad, down, or irritable mood more than 2 weeks?
what is manic episode?
mania (abnormally elevated, expansive or irritable mood) plus 3 or 4 other symptoms
what is the affect range from the most exciting state to the lowest?
mania –> hypomania –> euthymia (normal mood) –> dysthymia –> depression
what is hypomanic episode?
hypomania (elevated, expansive, or irritable mood, less severe and shorter duration than mania) plus 3 or 4 other symptoms
what is mixed episode?
meets criteria for both a manic episode and a major depressive episode
what is bipolar 1?
mania + MDE (major depressive disorder)
to be qualified as bipolar 1 what do you need?
must have mania, do not need to have depression
what is bipolar 2?
hypomania + MDE
to be qualified as bipolar 2 what do you need?
must have hypoMANIA, do not need to have depression
what is cyclothymia?
more than 2 yrs of hypomania with minor depressions
Occurrence of biopolar?
1% Lifetime prevalence: Women = Men in Bipolar 1
Greater for Bipolar 2 where women > Men
Biological Factors of bipolar?
- Altered neurotransmitter activity (Increase of DA, SR, NE)
- Monoamine Receptor Deficiency theory (opposite of depression)
- Genetics (high association)
- Kindling Hypothesis
- Too much neuronal firing in the limbic system
Seizure and anti-epilepsy drug model via Na++ channel blockade
Antidepressants for Bipolar Depression?
- Try not to use them. Avoid antidepressants that increase multiple monoamine neurotransmitters and favor lower doses of much simpler mechanistic SSRI(selective serotonin reuptake inhibitors)
- If you have to use them, make sure a mood stabilizer is used first to help prevent antidepressant alone from causing increased mania and instability
Antipsychotics for Bipolar?
- Some atypical antipsychotics, initially approved for schizophrenia have now been approved for treating bipolar depression, why?
–> They block the dopamine-2 receptor which treats mania or helps prevent it
–> All block 5HT2a receptors which treats depression
Some stimulate 5HT1a receptors “ “ “ “
Some have SSRI properties
Some have NRI properties
Some block 5HT2c, 5HT3, 5HT7 all of which have antidepressant inklings - THEY ARE UNIQUELY SUITED TO TREAT BOTH SIDES OF BIPOLARITY
Liithium has less data but is also a good choice….
does psychotherapy does work bipolar?
no does not work, medication management is critical
bipolar used to be called
manic depression
in order to qualified as bipolar
At least 3 symptoms must be present for at least 2 weeks:
- Increased self esteem/grandiosity
- Decreased sleep
- Increased speech
- Racing thoughts
- Distractibility
- *Increased activity (and energy is key for DSM 5)
- Increased dangerous impulsivity
Bipolar I defined
by the presence of at least 1 manic episode with or without a hypomanic or depressive episode.
Bipolar II defined
by the presence of a hypomanic and a depressive episode.
Patient’s mood and functioning usually return to
normal between episodes. Use of antidepressants can lead to mania. High suicide risk. Treatment: mood stabilizers (e.g., lithium, valproic acid,
carbamazepine), atypical antipsychotics.
Cyclothymic disorder—
dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.
Major Depressive EPisode
Pervasive sad, down, or irritable mood
> 2 weeks
*Must cause distress/dysfunction
**Cannot be due to another disorder, medical condition, substance misuse
mood level (affect of range)
mania –> hypomania –> euthymia –> dysthymia –> depression
dysthymia means
half depressed
manic episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and
abnormally and persistently increased activity or energy lasting at least 1 week. Often disturbing
to patient.
Diagnosis requires hospitalization or at least 3 of the following (manics DIG FAST):
Distractibility
Irresponsibility—seeks pleasure without
regard to consequences (hedonistic)
Grandiosity—inflated self-esteem
Flight of ideas—racing thoughts
in goal-directed Activity/psychomotor
Agitation
need for Sleep
Talkativeness or pressured speech
bipolar 1
must be manic or depressed
Bipolar I defined by the presence of at least 1 manic episode
with or without a hypomanic or depressive episode.
bipolar type 2 is
hypomania + full depression
cyclothymia
with one minor depression + more than hypomania
other characteristics of biopolar?
- Increase sexual activity
- Increase in seductive, flashy dress with increased accessorizing
- Increase anger and escalation
- Increase energy, able to work more, able to be more creative, think out of the box, take chances
- Can become psychotic
- Delusions
- Hallucinations
- Thought disorder
what are the biological factors for bipolar?
Biological Factors
- Altered neurotransmitter activity (Increase of DA, SR, NE)
- Monoamine Receptor Deficiency theory (opposite of depression)
- Genetics (high association)
- Kindling Hypothesis
- Too much neuronal firing in the limbic system
- Seizure and anti-epilepsy drug model via Na++ channel blockade
occurance of bipolar 1
1% lifetime, women = men
occurance of bipolar 2
- greater for bipolar 2
- women > men (women have more depression)
bipolar 1
must have mania, but do not need to have depression
bipolar 2
must have hypoMANIA, but do not need to have depression
for bipolar
do not give antidepressent unless mood stabilizer is given
blocking 5HT2a lowers
EPS symptoms
what can treat mania or helps preven it?
blocking dopamine -2 receptor
anti-manic agents
- lithium - provides Ca++ membrane stability –> promotes neuronal health and protective factors
- divalproex –> increase GABA activity
- Carbamazepine- blocks Na+ channels and promotes neuronal health…
- Atypical Antipsychotics- All block D2 receptors and ? Increase neuronal health and connectivity…..
Risperidone, Aripiprazole
Olanzapine, Asenapine
Quetiapine
side effects of lithium
hurt thyroid and kidney
for bipolar psychotherayp
- Does work for the depressed phase
- Many forms and styles will help
- During maintenance phase, education is key
summary for bipolar
Name the types of bipolar spectrum disorders and identify from vignettes or patient history
Know the causes of mania
Know how to treat mania
Know how to treat bipolar depression
