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bipolar Flashcards

1
Q

in order to be qualified as mania

A

distinct, abnormal, elevated, expansive (or irritable mood) X 7 days minimum

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2
Q

in order to be qualified as mania at least what 3 symptoms must be present for at least 2 weeks?

A
  1. increased self esteem/grandiosity
  2. decreased sleep
  3. increased speech
  4. racing thoughts
  5. distractibility
  6. increased activity (and energy is key for DSM5)
  7. increased dangerous impulsivity
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3
Q

DTRHIGH

A 
Distractible
Talkative
Racing thoughts
Hyperactive
Impulsive
Grandiose
Hyposomnic
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4
Q

what is hypomania?

A
  • 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
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5
Q

what is major depressive episode?

A

pervasive sad, down, or irritable mood more than 2 weeks?

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6
Q

what is manic episode?

A

mania (abnormally elevated, expansive or irritable mood) plus 3 or 4 other symptoms

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7
Q

what is the affect range from the most exciting state to the lowest?

A

mania –> hypomania –> euthymia (normal mood) –> dysthymia –> depression

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8
Q

what is hypomanic episode?

A

hypomania (elevated, expansive, or irritable mood, less severe and shorter duration than mania) plus 3 or 4 other symptoms

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9
Q

what is mixed episode?

A

meets criteria for both a manic episode and a major depressive episode

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10
Q

what is bipolar 1?

A

mania + MDE (major depressive disorder)

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11
Q

to be qualified as bipolar 1 what do you need?

A

must have mania, do not need to have depression

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12
Q

what is bipolar 2?

A

hypomania + MDE

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13
Q

to be qualified as bipolar 2 what do you need?

A

must have hypoMANIA, do not need to have depression

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14
Q

what is cyclothymia?

A

more than 2 yrs of hypomania with minor depressions

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15
Q

Occurrence of biopolar?

A

1% Lifetime prevalence: Women = Men in Bipolar 1

Greater for Bipolar 2 where women > Men

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16
Q

Biological Factors of bipolar?

A
  1. Altered neurotransmitter activity (Increase of DA, SR, NE)
  2. Monoamine Receptor Deficiency theory (opposite of depression)
  3. Genetics (high association)
  4. Kindling Hypothesis
  5. Too much neuronal firing in the limbic system
    Seizure and anti-epilepsy drug model via Na++ channel blockade
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17
Q

Antidepressants for Bipolar Depression?

A
  1. 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)
  2. 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
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18
Q

Antipsychotics for Bipolar?

A
  1. 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
  2. THEY ARE UNIQUELY SUITED TO TREAT BOTH SIDES OF BIPOLARITY
    Liithium has less data but is also a good choice….
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19
Q

does psychotherapy does work bipolar?

A

no does not work, medication management is critical

20
Q

bipolar used to be called

A

manic depression

21
Q

in order to qualified as bipolar

A

At least 3 symptoms must be present for at least 2 weeks:

  1. Increased self esteem/grandiosity
  2. Decreased sleep
  3. Increased speech
  4. Racing thoughts
  5. Distractibility
  6. *Increased activity (and energy is key for DSM 5)
  7. Increased dangerous impulsivity
22
Q

Bipolar I defined

A

by the presence of at least 1 manic episode with or without a hypomanic or depressive episode.

23
Q

Bipolar II defined

A

by the presence of a hypomanic and a depressive episode.

24
Q

Patient’s mood and functioning usually return to

A

normal between episodes. Use of antidepressants can lead to  mania. High suicide risk. Treatment: mood stabilizers (e.g., lithium, valproic acid,
carbamazepine), atypical antipsychotics.

25
Q

Cyclothymic disorder—

A

dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.

26
Q

Major Depressive EPisode

A

Pervasive sad, down, or irritable mood
> 2 weeks
*Must cause distress/dysfunction
**Cannot be due to another disorder, medical condition, substance misuse

27
Q

mood level (affect of range)

A

mania –> hypomania –> euthymia –> dysthymia –> depression

28
Q

dysthymia means

A

half depressed

29
Q

manic episode

A

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):
ƒƒDistractibility
ƒƒ Irresponsibility—seeks pleasure without
regard to consequences (hedonistic)
ƒƒGrandiosity—inflated self-esteem
ƒƒ Flight of ideas—racing thoughts
ƒƒ  in goal-directed Activity/psychomotor
Agitation
ƒƒ  need for Sleep
ƒƒ Talkativeness or pressured speech

30
Q

bipolar 1

A

must be manic or depressed

31
Q

Bipolar I defined by the presence of at least 1 manic episode

A

with or without a hypomanic or depressive episode.

32
Q

bipolar type 2 is

A

hypomania + full depression

33
Q

cyclothymia

A

with one minor depression + more than hypomania

34
Q

other characteristics of biopolar?

A
  1. Increase sexual activity
  2. Increase in seductive, flashy dress with increased accessorizing
  3. Increase anger and escalation
  4. Increase energy, able to work more, able to be more creative, think out of the box, take chances
  5. Can become psychotic
  6. Delusions
  7. Hallucinations
  8. Thought disorder
35
Q

what are the biological factors for bipolar?

A

Biological Factors

  1. Altered neurotransmitter activity (Increase of DA, SR, NE)
  2. Monoamine Receptor Deficiency theory (opposite of depression)
  3. Genetics (high association)
  4. Kindling Hypothesis
    - Too much neuronal firing in the limbic system
    - Seizure and anti-epilepsy drug model via Na++ channel blockade
36
Q

occurance of bipolar 1

A

1% lifetime, women = men

37
Q

occurance of bipolar 2

A
  • greater for bipolar 2

- women > men (women have more depression)

38
Q

bipolar 1

A

must have mania, but do not need to have depression

39
Q

bipolar 2

A

must have hypoMANIA, but do not need to have depression

40
Q

for bipolar

A

do not give antidepressent unless mood stabilizer is given

41
Q

blocking 5HT2a lowers

A

EPS symptoms

42
Q

what can treat mania or helps preven it?

A

blocking dopamine -2 receptor

43
Q

anti-manic agents

A
  1. lithium - provides Ca++ membrane stability –> promotes neuronal health and protective factors
  2. divalproex –> increase GABA activity
  3. Carbamazepine- blocks Na+ channels and promotes neuronal health…
  4. Atypical Antipsychotics- All block D2 receptors and ? Increase neuronal health and connectivity…..
    Risperidone, Aripiprazole
    Olanzapine, Asenapine
    Quetiapine
44
Q

side effects of lithium

A

hurt thyroid and kidney

45
Q

for bipolar psychotherayp

A
  1. Does work for the depressed phase
  2. Many forms and styles will help
  3. During maintenance phase, education is key
46
Q

summary for bipolar

A

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

BS (15 decks)

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