Bipolar Flashcards
Bipolar epidemiology
25% of all mood
Bipolar
Risk factors
*majority first episode BEFORE 25
*mean onset 18 years
Old
*mixed episodes more in younger than older
*
Bipolar in women
- 1st mood is depressive = women, in men its mania
- women more rapid cycling
- possible: hypothyroid, hormones, more antidepression
Consequences of Bipolar
- suicide = 15x
- Bipolar = 1/4 all suicides
- co-existing anxiety disorder
- divorce = 2-3x normal
- more likely unemployed
Bipolar etiology
- shares genetic origin with Schizophrenia
- twins = 50-75% chance
- chaotic childhood events
- HPA axis/cortisol
- HPituitaryThyroid dysfunction = bluented TSH response / hypothryoidism
Bipolar 1 vs 2
1 = full blown mania/depression
2 = not full mania
Cyclothymia = each extreme not full
DSM 5
Abnormally Elevated/irritable mood + persistently increased goal-directed activity/energy MIN 1 WEEK W/ 3+: *inflated self esteem/grandiosit *decreased need for sleep *pressured speech/talkative *flight of ideas *distractibility *UP goal-directed activity *excessive involvement in risky behavior
DSM 5 hypomania
- same as mania but 4 DAYS
- not severe enough for marked impairment
- need family member to help
- less AGITATION
- HAVE CYCLES
- typically dx monopolar depression
How to Dx
BP 1
BP2
Cyclothymia
1 = just one manic episode
2= one hypomanic + one major depressive
Cyclothymia = chronic, bipolar-like condition, not meeting threshold (days severity) for major depression at least 2 years
Grandiosity
Personality vs. bipolar
Never leaves in personality disorder
Medication-induced bipolar
Right after med use
- cocaine
- corticosteroids
- stimulants
NOT if s/s prior to use
Other bipolar related syndromes
Other condition : thyroid, SLE, excess cortisol, TBI, MS
Depressed : mania
BP 1 = 3:1
BP 2 = 37:1
Often misdiagnosed as major depressive
Best dx strategy
Ask family
Specifiers
- w/ anxious distress
- w/ mixed features
*rapid cycling = 4 more episodes per year
BP differents
- unipolar major depressive
- schizoaffective
- schiz
- adhd
- Borderline
- substance abuse
BP comorbidities
- 1 other axis 1 usually (major spyc)
- substance use
- anxiety
- personality disorder
- ADHD
Mania vs depression
Mania abrupt, depression gradual
BP
Tx themes
- Aggressive
- Long term
- S/s every 9-12 months
- recurrence = rx non-adherence, environmental stress, sleep disruption
- acute episodes + mainenance of euthymia
Kindling Theory of Bipolar Disorder
- Treat early
* cycles get worse as time goes on
BP/Depression most dangerous time
When physical s/s gone , mood still remains (increased suicide)
Tx acute mania w/o psychosis
- SAFETY = admit if unsafe
- on anti-depressant? Lower/stop
- 1st line = valproate (no female able to get pregnant)
- Lithium = slower onset than valproate
- Benzo short-term for agitation
- Carbamezipine/gabapentine, lamotrigine/topiramate NOT FOR ACUTE MANIA
Acute mania w/ Psychosis
- SAFTEY FIRST
- lithium/valproate + antipsych
- olanzapine/quetiapine/risperidone
- lower anti-depressant
Hospitalization options
- inpatient - ALL suicidal/homicidal/hallucinations/inability to care (live alone)
- Partial hospitalization = moderately ill, family (if don’t come you are inpatient)
- outpatient = less acute, family, good w/ meds
Maintenance
*goal: monotherapy w/ mood stabilizer
1st Line (in order:
- Lithium (reduces suicide)
- Valproate
- Quetiapine
- Lamotrigine (not getting out of acute)
Rxs
*lithium/valproate = must monitor toxicity
Monitor for :
- tx failure (live event change? New other med?)
- suicidality
- incipient depression/mania
- bone marrow toxicity
- inadequate serum levels
- excess serum levels
Bipolar Disorder = psychotherapy
- goal = med adherence
- ID recurrence
- promote regular sleep/social patterns
- group therapy, CBT, family therapy
