Bipolar

Question 1

Define mania.

Answer 1

Distinct period of abnormally & persistently elevated, expansive, or irritable mood lasting at least 7 days (“distinct, abnormal, elevated, expansive”). At least 3 symptoms for at least 2 weeks: Increased self-esteem/grandiosity, decreased sleep, increased/pressured speech, racing thoughts, distractibility, increased activity & energy, increased dangerous impulsivity (“DTRHIGH” - Distractible, Talkative, Racing thoughts, Hyperactive, Impulsive, Grandiose, Hyposomnic). Must cause distress/dysfunction. Cannot be due to another disorder.

Question 2

What is hypomania?

Answer 2

Milder mania lasting 4+ days with the same symptoms but not severe enough to cause marked impairment.

Question 3

Define Bipolar 1, Bipolar 2, Cyclothymia?

Answer 3

Bipolar 1: Mania +/- Major Depressive Episode. Bipolar 2: Hypomania +/- Major Depressive Episode. Cyclothymia: >2 years hypomania with minor depressions.

Question 4

Can bipolar patients be psychotic?

Answer 4

Yes: Delusions, Hallucinations, Thought Disorders can occur.

Question 5

What biological factors/theories exist for bipolar? Can psychological factors play a role?

Answer 5

High association with genetics. Altered NT activity (increased DA, NE, 5HT). Monoamine Receptor Deficiency Theory. Kindling Hypothesis: Too much neuronal firing in the limbic system. Psychological factors, such as stress or low self esteem, can probably also contribute.

Question 6

Should antidepressants be used for bipolar disorder? Why or why not? If they are used, how should they be used?

Answer 6

No. Avoid those that increase monoamines. If they must be used, use low doses of simple drugs (SSRIs) after use of a mood stabilizer.

Question 7

Should antipsychotics be used for bipolar? Why or why not? How do they work?

Answer 7

They can be, especially atypical antipsychotics. They block DA2R (treats/prevents mania) and 5HT2AR (treats depression). (“Uniquely suited to treat both sides of bipolarity.”)

Question 8

Does psychotherapy work for mania? What about depressive episodes?

Answer 8

No & no.

Question 9

How are manic episodes treated? For any drugs, give MOA.

Answer 9

Medically. Lithium (provides Ca2+ membrane stability, promotes neuronal health & protective factors). Divalproex (increase GABA). Carbamazepine (Block Na channels and promote neuronal health). Atypical antipsychotics (Block D2R) – exs include: Risperidone, Olanzapine, Asenapine, Quetiapine, Aripiprazole.