Bipolar

Question 1

What is the requirement for a diagnosis of a manic episode?

Answer 1

Persistently elevated expansive or irritable mood, with increased energy for at least 1 week and present most of the day and nearly every day.

Question 2

What are the 7 main symptoms that can occur during a manic episode?

Answer 2

1. inflated self esteem
2. decreased need for sleep
3. more talkative than usual
4. flight of ideas; thoughts are racing
5. distractability
6. increase in goal-directed activity
7. excessive involvement in pleasurable activities that have high potential for negative consequences.

Question 3

What is the difference between a manic episode and a hypomanic episode?

Answer 3

A manic episode must last for at least 1 week, while a hypomanic episode must last for at least 4 days. A manic episode must cause marked impairment in functioning while a hypomanic episode does not have to. A manic episode may have psychosis symptoms but a hypomanic episode does not.

Question 4

What is the difference between bipolar I and bipolar II disorder?

Answer 4

Bipolar I has at least 1 manic episode which is followed by at least 1 depressive episode. Bipolar II has one depressive episode, one or more hypomanic episodes, and no prior history of a manic episode

Question 5

If the mood is only irritable in bipolar disorder, how many of the 7 main symptoms need to be present for a diagnosis of bipolar I or II?

Answer 5

3 is normally required, but 4 are needed if the mood is ONLY irritable.

Question 6

What are 3 specifiers for bipolar disorder?

Answer 6

1. with anxious distress
2. with mixed features (like manic or hypomanic episode with mixed features, or depressive episode with mixed features, meaning that a manic/hypomanic episode has depressive symptoms and a depressive episode has some manic symptoms)
3. with rapid cycling: presence of four mood episodes in the previous 12 months (5-15% of individuals with bipolar)

Question 7

What can be used to assess a manic episode?

Answer 7

Altman self-rating mania scale; score of > or = 6 indicates high likelihood of manic or hypomanic episode

Question 8

What is the lifetime prevalence of bipolar I and II?

Answer 8

3.9%

Question 9

What is the age of onset of bipolar?

Answer 9

late teens or early 20’s

Question 10

If there is an individual with bipolar, what is the percentage of major depression in relatives? Of bipolar?

Answer 10

MDD in relatives = 15%

BP in relatives - 8%

Question 11

What is the most common psychiatric illness in family members of an individual with bipolar disorder?

Answer 11

Major depression

Question 12

What percentage of adult life do individuals with bipolar spend ill, and what percentage of that is spent in depressive episodes?

Answer 12

50% of adult life is ill, 2/3 of that time is depression

Question 13

What are the 3 phases of treatment?

Answer 13

Acute, continuation, and maintenance phase

Question 14

What are the two main classes of drug for acute mania?

Answer 14

Can use mood stabilizers (lithium, anticonvulsants) and atypical antipsychotics

Question 15

What are benzodiazepines used for in bipolar disorder?

Answer 15

Used to initiate sleep or reduce agitation in manic patients

Question 16

What are antidepressants used for in bipolar disorder?

Answer 16

Used to treat the depressive phase of bipolar

Question 17

When should antidepressants be used with mood stabilizers concurrently?

Answer 17

ONLY in the cases of bipolar I disorder. This is because a BP I patient may develop an iatrogenic mania if an antidepressant is given without a mood stabilizer

Question 18

What is IPSRT?

Answer 18

Based on the instability model of bipolar disorder, treatment is psychoeducational, interpersonal, and behavioral strategies to reduce symptoms. Regulates social cues to establish a daily rhythm.

Question 19

What are 3 common psychiatric comorbidities and waht are 4 common general medical comorbidities?

Answer 19

Psych: Anxiety d/o, personality d/o, and substance use d/o

General med: metabolic, cardiovascular, thyroid disease, migraines