Bipolar Flashcards
Background Info of BP I:
- Prevalence: __ to __% (narrow vs spectrum)
- Onset in young adulthood (if BP develops in people >60 years, it may be from a general ___ disorder that should be first consideration)
- Chronic episodic course
- Significant ___ (disability, hospitalization, adjustment, substance problems, psychiatric disorder, medical issues)
- Significant ____ (suicide, accidents, and medical co-morbidities)
Background Info of BP I:
- Prevalence: 1 to 4% (narrow vs spectrum)
- Onset in young adulthood (if BP develops in people >60 years, it may be from a general medical disorder that should be first consideration)
- Chronic episodic course
- Significant morbidity (disability, hospitalization, adjustment, substance problems, psychiatric disorder, medical issues)
- Significant mortality (suicide, accidents, and medical co-morbidities)
Patients with bipolar I have had at least ___ manic episode (lasting at least ___ wk) that includes at least ____ of the DIG FAST criteria.
DIG FAST (for BP I and II)
- ___- poorly focused, multitasking
- ___ - decreased need for sleep
- ___ - inflated self-esteem
- __ of ___ - complaints of racing thoughts
- Activity, Agitation, such as putting in significantly more work into projects or increase in sexual activity
- ___ – pressured, rapid more talkative speech
- ____– engaging in pleasurable activities with negative consequences, such as gambling, driving, sexual, shopping sprees
Manic episode (can last up to __ months if untreated) leads to marked impairment in function or there are psychotic features
Patients with bipolar I have had at least one manic episode (lasting at least 1 wk) that includes at least three of the DIG FAST criteria.
DIG FAST (for BP I and II)
- Distractibility - poorly focused, multitasking
- Insomnia - decreased need for sleep
- Grandiosity - inflated self-esteem
- Flight of ideas - complaints of racing thoughts
- Activity, Agitation, such as putting in significantly more work into projects or increase in sexual activity
- Speech – pressured, rapid more talkative speech
- Thoughtlessness – engaging in pleasurable activities with negative consequences, such as gambling, driving, sexual, shopping sprees
Manic episode (can last up to 3 months if untreated) leads to marked impairment in function or there are psychotic features
___ - A milder form of BP, lasting at least __ years, fluctuating between mild depressive and hypomanic symptoms
Cyclothymia - A milder form of BP, lasting at least 2 years, fluctuating between mild depressive and hypomanic symptoms
Bipolar II:
Symptoms: _____ episode = DIGFAST, but no ___ features, not severe enough to cause marked impairment in function or hospitalization
Episode of Major Depression = SIGECAPS Elevated, expansive, irritable mood for __ days.
These patients may have stories similar to those with bipolar I, but they have never had a ___ episode. Instead, they have had at least ___ major ___ episodes and at least one ____ episode.
A __ episode only needs to last __ days (unlike 7 for a manic episode) and is ___ severe than a manic episode.
These patients have DIG FAST symptoms, but are not as severely impaired.
I.E. Think of a college student who has been irritable for the past few days, speaks quickly with rapidly changing topics, and has been spending all the time working on a project for a robotics class, even foregoing sleep.
Bipolar II:
Symptoms: hypomanic episode = DIGFAST, but no psychotic features, not severe enough to cause marked impairment in function or hospitalization
Episode of Major Depression = SIGECAPS Elevated, expansive, irritable mood for 4 days.
These patients may have stories similar to those with bipolar I, but they have never had a manic episode. Instead, they have had at least one major hypomanic episodes and at least one depressive episode.
A hypomanic episode only needs to last 4 days (unlike 7 for a manic episode) and is less severe than a manic episode.
These patients have DIG FAST symptoms, but are not as severely impaired.
I.E. Think of a college student who has been irritable for the past few days, speaks quickly with rapidly changing topics, and has been spending all the time working on a project for a robotics class, even foregoing sleep.
Epidemiolgoy of BP:
Lifetime prevalence (adults)
Bipolar I: __ to ___%
Bipolar II: __ to __ % (Both may be underestimates)
Age of onset:
Mean age __ years (up to 25) Peak age __ to ___ years
Gender
Bipolar I male ___ female
Bipolar II female ___ male
**Epidemiolgoy of BP:** _Lifetime prevalence (adults)_
Bipolar I: 0.8% to 1.6%
Bipolar II: 0.5% to 5.5% (Both may be underestimates)
Age of onset:
Mean age 21 years (up to 25) Peak age 15 to 19 years
Gender
Bipolar I male = female
Bipolar II female > male
Comorbidities:
- ___ ___: up to 60%
- ____: 42%
- ____ phobia: 18-40%
- __ __ __: 7.4-35.0%
- __ disorders: 5%
- ___ headaches: 8.6-44.0%
Comorbidities:
- Substance abse: up to 60%
- Anxiety: 42%
- Social phobia: 18-40%
- Obsessive Compulsive Disorder: 7.4-35.0%
- Eating disorders: 5%
- Migraine headaches: 8.6-44.0%
- *Bipolar Etiology:**
1. ____—90% concordance in identical twins
- Decreased activity in ___ ___ cortex leading to trouble with volitional affect regulation (a will to commit or do something).
- Decreased activity in ___ ___ cortex leading to trouble with executive function
- Abnormalities in ___ ___ cortex leading to trouble with affect regulation (affect regulation, or emotion regulation, is the ability of an individual to modulate their emotional state in order to adaptively meet the demands of their environment).
- Smaller ___ volume
- Smaller ____ volume leading to difficulty with assessment and interpretation of emotion and disproportionate emotional responses
- *Etiology:**
1. Genetics—90% concordance in identical twins
- Decreased activity in ventrolateral prefrontal cortex leading to trouble with volitional affect regulation
- Decreased activity in dorsilateral prefrontal cortex leading to trouble with executive function
- Abnormalities in anterior cingulate cortex leading to trouble with affect regulation
- Smaller hippocampal volume
- Smaller amygdala volume leading to difficulty with assessment and interpretation of emotion and disproportionate emotional responses
Consequences of BP:
- Impaired _____
- Disrupted _____
- On average men with ___ years shorter life span and women ___ years
- High ____ rate (___%)
- ____disasters
- Alcohol and other substance ___
Consequences of BP:
- Impaired functioning
- Disrupted relationships
- On average men with 11 years shorter life span and women 10 years
- High suicide rate (19%)
- Financial disasters
- Alcohol and other substance abuse
Treatments or BP:
- _____: cognitive-behavioral, interpersonal
- Mood ____ +/- anti___, benzos
- Antipsychotics (can lead to ____ syndromes, obesity, ___ gain, DM)
Medications: OR-ZAQ
- ____
- ____
- ____
- ____
- ____
- ____ ___ ____ for severe depression, psychosis
- Combo ___ + medications
- Medications for Acute Mania
FDA approved: L____, C____, V_____, D____, Thorazine, Olanzapine, Risperidone, Ziprasidone, Aripiprazol, Quetiapine
Treatments or BP:
- Psychotherapy: cognitive-behavioral, interpersonal
- Mood stabalizer +/- antipsychotics, benzos
- Antipsychotics (can lead to metabolic syndromes, obesity, weight gain, DM)
Medications: OR-ZAQ
- Olanzapine
- Risperidone
- Zisprasidone
- Aripriprazole
- Quetiapine
- Electroconvulsive therapy for severe depression, psychosis
- Combo psychotherapy + medications
- Medications for Acute Mania
FDA approved: Lithium, Carbamezapine, Valproate, Divalproex, Thorazine, Olanzapine, Risperidone, Ziprasidone, Aripiprazol, Quetiapine
Metabolic Side Effects of BP Meds
- ____ obesity
- _____ dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high ___ cholesterol)
- Elevated __ __
- ___resistance or ___ intolerance
- ___ state (e.g., high fibrinogen or plasminogen activator inhibitor–1)
- ____ state (e.g., elevated __-reactive protein)
Metabolic Side Effects of BP Meds
- Abdominal obesity
- Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol)
- Elevated blood pressure
- Insulin resistance or glucose intolerance
- Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1)
- Proinflammatory state (e.g., elevated C-reactive protein)
Side Effect of BP Meds –> EPS - Extrapyramindal Syndromes
- ____— a subjective feeling of restlessness
- ___ ___ reactions—abrupt onset muscular spasms of the neck, eyes, trunk, extremities*
- ____—stiffness, tremor, impaired gait *Chronic dopamine blockade can lead to __ __.
Side Effect of BP Meds –> EPS - Extrapyramindal Syndromes
- Akathsia— a subjective feeling of restlessness
- Acute dystonic reactions—abrupt onset muscular spasms of the neck, eyes, trunk, extremities*
- Parkinsonism—stiffness, tremor, impaired gait *Chronic dopamine blockade can lead to tardive dyskinesia
BP Med Side Effects (usually caused by atypical bp meds)
NMS - __ ___ __
- ____ (0.01%) reaction to dopamine antagonists
- Hyper____, hyper___, profuse ___ (sweating)
- Lead pipe ____, _____ (breakdown of muscle tissue), tremor
- ___ ___ levels 4x upper limit of normal 10-20% mortality if unrecognized
*Reported with essentially every ___or ___ antagonist including non-psychotropics such as ____ (Reglan)
BP Med Side Effects:
NMS - Neuroleptic Malignant Syndromes
- Idiosyncrasy (0.01%) reaction to dopamine antagonists
- Hyperthermia, hypertension, profuse diaphoresis (sweating)
- Lead pipe rigidity, rhabdomyolosis (breakdown of muscle tissue), tremor
- Elevated CK levels 4x upper limit of normal 10-20% mortality if unrecognized
*Reported with essentially every D1 or D2 antagonist including non-psychotropics such as metoclopramide (Reglan)
A BP Med Side Effect:
__ ___: A movement disorder that may occur following long-term treatment with antipsychotic medications.
Movements may include:
- __ and __ movements (lip smacking, sucking and puckering as well as facial grimacing)
- irregular movements of the limbs, particularly choreoathetoid-like movements of the fingers and toes
- slow, writhing movements of the trunk - mild- disabling - often irreversible.
A BP Med Side Effect:
Tardive Dyskinesia: A movement disorder that may occur following long-term treatment with antipsychotic medications.
Movements may include:
- Mouth and tongue movements (lip smacking, sucking and puckering as well as facial grimacing)
- irregular movements of the limbs, particularly choreoathetoid-like movements of the fingers and toes
- slow, writhing movements of the trunk - mild- disabling - often irreversible.
Tardive Dyskinesia - movement disorder due to _____ use.
Presentation: commonly observed symptoms are chewing movements, lip-smacking, and rolling of the tongue inside mouth and up against the cheek. The limbs and trunk may also be affected.
A history of use of ___-___ blocking drugs is essential to the diagnosis.
___-____ (including haloperidol) are the most common causes of drug-induced movement disorders.
The propensity of a drug to cause these movement disorders is related to its __-___ blocking activity.
Tardive Dyskinesia - movement disorder due to neuroepileptic use.
Presentation: commonly observed symptoms are chewing movements, lip-smacking, and rolling of the tongue inside mouth and up against the cheek. The limbs and trunk may also be affected.
A history of use of dopamine receptor blocking drugs is essential to the diagnosis.
Anti-psychotics (including haloperidol) are the most common causes of drug-induced movement disorders.
The propensity of a drug to cause these movement disorders is related to its D2-receptor blocking activity.
FDA aproved drugs for Acute Mania are:
LCD TOR ZAQ
Lithium
Carbamezapine
Divalproex (for younger kids)
Thorazine
Olanzapine
Risperidone
Ziprasidone
Aripriprazole
Quetiapine
