BIPOLAR

Question 1

What is the recurrence rate of bipolar? What about in the first year?

Answer 1

90% First year = 50%

Question 2

What are the 4 subtypes of bipolar disorder?

Answer 2

Mixed mania; Rapid cycling; bipolar II; and Secondary mania

Question 3

What is mixed mania?

Answer 3

Simultaneous mania & depression

Question 4

What is rapid cycling?

Answer 4

more than 4 episodes/year

Question 5

What is bipolar II?

Answer 5

Hypomanis (LESS than 4 days duration; who is functional and extra-alert) that alternates with depression. Never had mania.

Question 6

What is secondary mania?

Answer 6

Due to an underlying disorder (drugs [steroids], tumor, CVA, SLE, infectious)

Question 7

Is there a genetic component to bipolar disorder?

Answer 7

Yes (more common in twins)

Question 8

What are the 2 ways you can figure out if there is a genetic component?

Answer 8

Linkage studies (find the gene within the disorder) & Association studies (compare variations in genes); possibly mitochondria dysfunction

Question 9

In general, at what age are people diagnosed with bipolar disorder?

Answer 9

Adolescence 13-18 years old (followed closely by early adulthood)

Question 10

What portion of the brain does bipolar mostly affect?

Answer 10

Anterior Limbic System (prefrontal cortex, amygdala, hippocampus)

Question 11

On average, a person with bipolar disorder is not diagnosed until when?

Answer 11

Nearly a decade after the onset of symptoms

Question 12

What are some of the diagnostic challenges of bipolar?

Answer 12

past records (poor prior history); vague diagnostic criteria; lack of validating biological markers; and depression is a common chief complaint during manic episodes

Question 13

What are the 3 phases of treating bipolar?

Answer 13

Acute; continuation; and maintenance/discontinuation

Question 14

What’s a difference between schizophrenia & bipolar?

Answer 14

Bipolar is highly functioning

Schizophrenia often declines over time

Question 15

How much of a person’s like with bipolar disorder is spent in the manic stage?

Answer 15

half of their life

Question 16

What is a manic episode?

Answer 16

Sleeplessness; look agitates, euphoric, or irritable; buying bulk of things that they don’t need or can’t explain why they have them (can even spend all the money they have – which is where the risk for recurrence)

Question 17

What is bipolar I?

Answer 17

They have one manic episode (also why it’s hard to treat; if someone has a manic episode at 20 they often forget when they are 50 what it was like and therefore they might not want to treat)

Question 18

How do you treat acute mania?

Answer 18

Lithium or valproate or antipsychotic (go with the lithium unless they also have psychosis)

Remember tardive dyskinesia are permanent

Question 19

How do you treat a bipolar patient with depression?

Answer 19

Lithium (can add an antidepressant)

Question 20

What is the maintenance treatment for bipolar?

Answer 20

Lithium or valproate

Alternatives: lamotrigine, carbamazepine, oxycarbazepine

Atypical antipsychotics can be considered

Question 21

How long does lithium take to get to full effect?

Answer 21

14 days; which you may need to use a benzo in the mean time

Question 22

What is an advantage to lithium?

Answer 22

It decreases suicide rate

Question 23

How do you evaluate mania?

Answer 23

Elevated mood, increased motor activity, irritability, speech, content, disruptive/aggressive behavior

Question 24

What 3 mood stabilizers, used to treat bipolar, are FDA approved?

Answer 24

Lithium, Depakote, and Lamictal

Question 25

Any treatment for depressant carries the risk of what in a bipolar patient?

Answer 25

Causing mania

Question 26

What type of antidepressant will increase the risk of a mania episode?

Answer 26

Tricyclic antidepressants