Bipolar

Question 1

big chars of mania (need how many of 7?)
descriptors
what is the predominant mood?
what is the cardinal symptom?

Answer 1

need 3+
Distractability
Increased activity
Grandiosity
Flight of ideas
Aggitation/irritability
Sleep
Talking fast

elevated/euphoric, expansive (enthusiasm, conversing w/strangers), irritable, labile affect

irritability
decreased need for sleep

Question 2

what tx to avoid in bipolar disorder?

Answer 2

MDD tx –> may exacerbate

Question 3

features of mood disorders

Answer 3

MDD: MDE, rarely mixed features
BP I: MDE (not req), mania, sometimes hypo/mixed
BP II: MDE (required), hypomania, sometimes mixed

Question 4

epi of bipolar
M:F?
median onset?

Answer 4

4%
3:2, but BP I equal in M/F
25y, men earlier than women
completed suicide in 10-15% of BP I
6th leading cause of disability due to non-infectious disease

Question 5

what to think if onset is >50y?

Answer 5

due to medical condition or meds

Question 6

2 co-morbid d/o’s with bipolar?

what two signs are a red flag in pts presenting with a depressive episode?

Answer 6

substance use/anxiety

alcohol misuse/panic attacks

Question 7

genetics of bipolar

Answer 7

1st degree relatives: 7x more likely
MZT: 33-90%
DZT: 5-25%

Question 8

neuroimaging of bipolar

Answer 8

enlarged ventricles
frontal lobe white matter lesions
decr gray matter in limbic sys

Question 9

metabolism: ant cingulate v. PFC

NAA levels? lithium’s effect?

Answer 9

up in AC and down in PFC
low levels of N-acetylaspartate in PFC/AC/Hippo
lithium raises NAA by blocking ITP pathway –> release brake on new synapse formation

Question 10

cortisol levels in bipolar?

cytokines?

Answer 10

incr cortisol

incr pro-inflam cytokines

Question 11

what env changes assoc w mania onset?

Answer 11

sleep disturbance/deprivation
travel changes in time zone
early fall/spring daylight changes

Question 12

psychosocial factors in bipolar (families)

Answer 12

families w/high expressed emotion have higher relapse rates

negative life events –> longer recovery and more likely to have new episodes

Question 13

medical conditions that cause/contribute to mania –> “BP d/o due to another condition”

Answer 13

endocrine (hyperthyroid
neuro (MS/huntington/epilepsy)
neoplasia (frontal lobe)
cerebrovasc disease (right frontal lobe)
infection (HIV/AIDS)
neurosyphilis
herpes encephalitis

Question 14

substances that cause/contribute to mania –> substance/med-induced bipolar d/o

Answer 14

stimulants: cocaine, amphets
antidepressants
glucocorticoids
antibiotics

Question 15

how long must episode last to be considered manic? how many required to be considered BP I?

Answer 15

at least 1 week for most of day

one lifetime episode

Question 16

type of speech, thoughts, and energy?

Answer 16

pressured: loud/rapid/hard to interpret
racing/disorganized (flight of ideas)
high/increased goal-directed activity

Question 17

a manic episode with simultaneous sx of MDE

Answer 17

mixed features

Question 18

pt has 4+ mood episodes per year?

what is this assoc w?

Answer 18

rapid cycling
younger age; more frequent depressive episodes; greater risk of suicide attempts
classic is 4 episodes every 10 years

Question 19

sx for how many days at least to be considered a hypomanic episode?
prominent symptom during hypomanic episodes?

Answer 19

4 consecutive
if there are psychotic features –> its manic
common but not required for BP I
irritability

Question 20

BP II main features

Answer 20

at least one hypomanic episode
at least one MDE
NEVER a manic episode

Question 21

acute tx of mania

Answer 21

rapid mood stabilization
LITHIUM is gold std
anticonvulsants: VA and oxcarbazepine
atypical antipsychotics: risper/olanz/quetia/zipras/aripip (IF PT HAS PSYCHOTIC SX)
BZD’s adjuncts for anx/agitation/insomnia
ECT for rapid resolution of severe or refractory depression/mania
psychotherapy NOT effective
take pt off SNRI

Question 22

acute tx of depressive episodes

Answer 22

NO ANTIDEPRESSANTS w/o a mood stabilizer: lithium, anticonvulsant, antipsychotic (lamotrigine)
psychotherapy
ECT

Question 23

maintenance treatment of bipolar

Answer 23

kindling: episodes more freq/severe/refractory over time…so primary goal is to REDUCE mood episode recurrence

–> lithium, lamotrigine, VA, atypical apsychs
2/3 pts don’t adhere to first year of tx

Question 24

bipolar co-morbid w?

Answer 24

substance use d/o –> may destabilize mood and result in recurrence

Question 25

psychosocial interventions for bipolar

Answer 25

psychotherapy and psychoeducation promote dec rate hospitalization, decr risk of relapse, improved adherence to meds

a) incr social support, b) teach importance of regulating sleep cycles, c) coping methods for stressful events

Question 26

psychosocial intervention where pts keep track of wake up/eat/first contact/go to sleep

Answer 26

interpersonal and social rhythm therapy

Question 27

what meds for manic & depressive sx?
anti-manics?
meds for bipolar depression?

Answer 27

lithium, quetiapine
lithium/VA/carbamazapine/atypicals/BZDs
lithium, quetiapine, olantrogine/fluoxetine, lamotrigine

Question 28

bipolar ddx

Answer 28

Bipolar I (lasts 7+ days)/II (lasts 4+ days)
substance abuse
depression (2+ weeks)
schizo