Bipolar Flashcards
big chars of mania (need how many of 7?)
descriptors
what is the predominant mood?
what is the cardinal symptom?
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
what tx to avoid in bipolar disorder?
MDD tx –> may exacerbate
features of mood disorders
MDD: MDE, rarely mixed features
BP I: MDE (not req), mania, sometimes hypo/mixed
BP II: MDE (required), hypomania, sometimes mixed
epi of bipolar
M:F?
median onset?
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
what to think if onset is >50y?
due to medical condition or meds
2 co-morbid d/o’s with bipolar?
what two signs are a red flag in pts presenting with a depressive episode?
substance use/anxiety
alcohol misuse/panic attacks
genetics of bipolar
1st degree relatives: 7x more likely
MZT: 33-90%
DZT: 5-25%
neuroimaging of bipolar
enlarged ventricles
frontal lobe white matter lesions
decr gray matter in limbic sys
metabolism: ant cingulate v. PFC
NAA levels? lithium’s effect?
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
cortisol levels in bipolar?
cytokines?
incr cortisol
incr pro-inflam cytokines
what env changes assoc w mania onset?
sleep disturbance/deprivation
travel changes in time zone
early fall/spring daylight changes
psychosocial factors in bipolar (families)
families w/high expressed emotion have higher relapse rates
negative life events –> longer recovery and more likely to have new episodes
medical conditions that cause/contribute to mania –> “BP d/o due to another condition”
endocrine (hyperthyroid neuro (MS/huntington/epilepsy) neoplasia (frontal lobe) cerebrovasc disease (right frontal lobe) infection (HIV/AIDS) neurosyphilis herpes encephalitis
substances that cause/contribute to mania –> substance/med-induced bipolar d/o
stimulants: cocaine, amphets
antidepressants
glucocorticoids
antibiotics
how long must episode last to be considered manic? how many required to be considered BP I?
at least 1 week for most of day
one lifetime episode
type of speech, thoughts, and energy?
pressured: loud/rapid/hard to interpret
racing/disorganized (flight of ideas)
high/increased goal-directed activity
a manic episode with simultaneous sx of MDE
mixed features
pt has 4+ mood episodes per year?
what is this assoc w?
rapid cycling
younger age; more frequent depressive episodes; greater risk of suicide attempts
classic is 4 episodes every 10 years
sx for how many days at least to be considered a hypomanic episode?
prominent symptom during hypomanic episodes?
4 consecutive
if there are psychotic features –> its manic
common but not required for BP I
irritability
BP II main features
at least one hypomanic episode
at least one MDE
NEVER a manic episode
acute tx of mania
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
acute tx of depressive episodes
NO ANTIDEPRESSANTS w/o a mood stabilizer: lithium, anticonvulsant, antipsychotic (lamotrigine)
psychotherapy
ECT
maintenance treatment of bipolar
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
bipolar co-morbid w?
substance use d/o –> may destabilize mood and result in recurrence
psychosocial interventions for bipolar
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
psychosocial intervention where pts keep track of wake up/eat/first contact/go to sleep
interpersonal and social rhythm therapy
what meds for manic & depressive sx?
anti-manics?
meds for bipolar depression?
lithium, quetiapine
lithium/VA/carbamazapine/atypicals/BZDs
lithium, quetiapine, olantrogine/fluoxetine, lamotrigine
bipolar ddx
Bipolar I (lasts 7+ days)/II (lasts 4+ days)
substance abuse
depression (2+ weeks)
schizo
