Bipolar Flashcards
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persisitently increased activity or energy, lasting 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary)
manic episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persisitently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
hypomanic episode
Elevated mood for 1 week or needing hospitalized
At least 3 of these:
Distractability Impulsivity Grandiosity Flight of ideas Activities, high risk Sleep, no need Talkative
Severe; marked impairment, needs hospitalized, or psychotic features
BIPOLAR I
inflated self esteem decreased sleep talkative flight of ideas distractibility increased goal directed activity high risk activities
Elevated mood for 4 days
At least 3 of these
Distractability Impulsivity Grandiosity Flight of ideas Activities, high risk Sleep, no need Talkative
- Uncharacteristic change in behavior and observable by others
- Not severe enough to cause marked impairment or hospitalization
BIPOLAR II
inflated self esteem decreased sleep talkative flight of ideas distractibility increased goal directed activity high risk activities
The essential feature is the manic episode
Depression or hypomania may or may not be present
The mood is frequently described as “being on top of the world” and is highly infectious
Rapidly shifting moods (i.e. euphoria to irritable to euthymic to euphoria etc…) is referred to as “liability”
May reach delusional levels of self esteem
Decreased need for sleep is a common feature
Vehemently resist efforts to be treated
Bipolar I
Acute mgmt of bipolar 1?
Valproic acid is a first-line treatment due to broader safety index
Lithium is very good at classic bipolar I but has multiple side effects and drug interaction
Second generation antipsychotic +/- benzodiazepine is great at acute management or for rapid cyclers
first-line treatment due to broader safety index for Bipolar 1
Valproic acid
Lithium is very good at classic ___ but has multiple side effects and drug interaction
bipolar I
Second generation antipsychotic +/- benzodiazepine is great at acute management or for ____
rapid cyclers
Long term mgmt of Bipolar 1….
First line therapy is typically to stay on whatever medication controlled the acute sxs.
Second line therapy options include
Lithium (Long term studies show some decreased risk of SI with this)
Valproate
Quetiapine
Lamotrigine
A ____ episode would rule out bipolar 2
manic episode rules out bipolar 2 becuase that would qualify it for bipolar 1
Hypomanic episode AND a major depressive episode?
bipolar 2
Major depressive episode =
SIGECAPS
depressed mood most of the day, nearly every day
diminished pleasure/interest
sig. wt loss
insomnia/hypersomnnia
psychomotor agitation
fatigue
feelings of worthlessness/guilt
diminished concentration
recurrent thoughts of death
At least one major depressive episodes
At least one hypomanic episode
If they have had a hypomanic episode and a depressive episode, a diagnosis of Bipolar II can be made
Typically present as a major depressive episode and unlikely to complain initially of hypomania
Please don’t confuse this with euthymia and/or energy that may follow a major depressive episode
Bipolar II
bipolar 2 mgmt?
same bipolar 1…
Acute management =
Valproic acid is a first-line treatment due to broader safety index
Lithium is very good at classic bipolar I but has multiple side effects and drug interaction
Second generation antipsychotic +/- benzodiazepine is great at acute management or for rapid cyclers
