Bipolar and related disorders

Question 1

what is required for diagnosis of BPD?

Answer 1

presence of a manic or mixed episode; no depressive episode is required

Question 2

what often precedes manic episodes?

Answer 2

psychosocial stressors

Question 3

what are the DSM 5 criteria for a manic episode?

Answer 3

distinct period of abnormally elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting at least one week, AND at least 3 of the following symptoms:

• inflated self esteem or grandiosity
• decreased need for sleep
• increased talkativity or pressure to talk
• flight of ideas or racing thoughts
• distractibility
• increase in goal directed activity
• excessive pleasurable activities that are likely to have negative consequences

Question 4

what are the ddx for BPD?

Answer 4

• hypomanic episode (bipolar affective disorder type II)
• psychotic disorder
• other specified / unspecified bipolar and related disorder
• substance / medication induced (mood disorder)
• due to another medical condition

Question 5

how do you differentiate bipolar disorders?

Answer 5

• bipolar I disorder: one or more manic or mixed episodes (no MDE required); hypomanic and depressive episodes
• bipolar II disorder: at least one hypomanic and at least one depressive episode without any manic or mixed episodes
• cyclothymia: 2 yrs of fluctuating periods of hypomanic and depressive symptoms that dont meet full criteria for those conditions

Question 6

what is the treatment of choice for BPD?

Answer 6

pharmacologic treatment - mood stabilizers (lithium, divalproex)

Question 7

what drug class alone can trigger a manic episode in an individual with underlying BPD?

Answer 7

anti depressants

Question 8

what is the role of antipsychotics for treatment of BPD?

Answer 8

treat mania, some treat depression