Bipolar/Depression Flashcards
The occurrence of ONE or more manic or mixed episodes, which may cycle with depressive episodes (but a depressive episode is NOT required for the diagnosis)
Bipolar I Disorder
Characterize by a sudden escalation of mood, which is abnormally and persistently euphoric, expansive, or irritable. Patients may go for days without sleep, become excessively talkative or loud, socially outgoing, overly self-confident, hyper sexual, or disinhibited. May display a flamboyant clothing style.
Manic episode
Can psychotic symptoms (hallucinations, paranoia, and delusions) be present during a manic episode?
Yes
What are the two most common misdiagnoses in a patient with Bipolar I disorder?
anxiety and MDD
Is Bipolar I thought to be genetic?
Yes! First-degree relatives have an increased risk, the odds of both monozygotic twins having bipolar if one has it is 75%
Characterized by at least one or more major depressive episode and at least one HYPOMANIC episode. Patient has never experienced a manic or mixed episode.
Bipolar II disorder
Similar to manic symptoms but less severe and cause less social impairment. This patient can FUNCTION NORMALLY. Marked by elation and hyperactivity.
Hypomanic episode
What are the requirements to diagnose a patient with Bipolar I?
ONE lifetime manic episode
How long does the average patient with bipolar go before receiving a proper diagnosis?
10 years
Simultaneous mania and depression, may make up 40% or more of episodes
Mixed mania
Rapid cycling bipolar disorder
More than 4 manic episodes/year
How do you diagnose bipolar II?
Must have hypomania (less than 4 DAYS duration) alternating with depression (uptodate says at least 1 major depressive episode) with the ABSENCE of mania symptoms
Mania caused by drugs, tumor, CVA, lupus, endocrine, infectious processes, Huntington’s disease and Wilson’s disease is called?
Secondary mania
What is the recurrence rate of bipolar disorder?
90%
Must occur during the same 2 week period as a manic/hypomanic episode and represent a change from a previous function. One of the symptoms MUST be a depressed mood or loss of interest or pleasure.
Depressive episode
1st line treatment for a normal acute mania/mixed mania bipolar episode
Lithium OR valproate OR a second gen antipsychotic
1st line treatment for a SEVERE acute mania/mixed mania bipolar episode
Lithium OR valproate + a second gen antipsychotic
1st line treatment for acute depression in a patient with bipolar
Lithium OR lamotrigine
1st line treatment for a SEVERE acute depression in a patient with bipolar
Lithium + antidepressant
Maintenance treatment for bipolar disorder
Lithium or valproate
Alternative maintenance treatment for bipolar disorder
Lamotrigine, carbamazepine, oxycarbazepine
Which maintenance treatments for bipolar are FDA approved?
Lithium, valproate, and lamotrigine
What are the two major drawbacks of lithium?
Slow onset - about 14 days; also very low therapeutic index
Is lithium proven to increase or decrease suicide rates in bipolar patients?
Decrease! :)
Why do patients not like taking lithium?
A lot of side effects (diabetes insidious, weight gain, tremors, somnolence, etc.)
Which patient has a higher chance of having a positive response to lithium - a patient who cycles through mania/depression/euthymia or a patient who cycles through depression/mania/euthymia?
Mania/depression/euthymia
Patient presents with a depressed mood most of the day nearly everyday, diminished interest/pleasure, insomnia/hypersomnia, fatigue/loss of energy, feelings of worthlessness, diminished concentration, thoughts of death/suicidal ideation for A 2 WEEK PERIOD!
Major depressive disorder
What is required for a diagnosis of MDD?
One or more major depressive episodes
Can patients with MDD develop manic episodes?
Yes, 5-10% do
Can patients who suffer from MDD fully remit?
Yes! Some do with or without medication in 6-12 months
What is anhedonia? (Only asking cause I keep seeing it and idk what it means)
Inability to feel pleasure
Depressed mood for most of the day, for more days than not, as indicated by patient account or others FOR TWO YEARS. This patient has criteria very similar to MDD, and may suffer from MDD, but they suffer from these symptoms during a TWO YEAR period and are only without depressive symptoms for no more than 2 MONTHS at a time.
Persistent depressive disorder
Can patients with PDD have manic or hypomanic episodes?
NO! If they have an episode it is not PDD.
Five or more DSM-5 criteria (not listing them sorry.. you can probably guess what they are “sad mood mood swings blah blah blah”) must be present THE WEEK BEFORE MENSES (get where I’m going with this?) and resolve a few days after menses starts. Documentation of physical and behavioral symptoms must be present for most of the preceding year.
Premenstrual dysphoric DO
How do you treat PMDD?
No clue, who cares
Lets talk about treatment for MDD and dysthymia.. what is your FIRST CHOICE drug going to be?
SSRI
For MDD and dysthymia - if an SSRI isn’t affective or your patient doesn’t like the side effects, what do you want to try next?
SNRI or bupropion, mirtazapine is also listed
If an SNRI and/or bupropion fail in your patient with MDD or PDD, what do you wanna try next?
TCAs
Why don’t patients like TCAs?
They can cause weight gain, orthostatic hypotension, anticholinergic effects, and somnolence
Whats the big deal with overdosing on a TCA?
Overdoses are usually lethal - whereas SSRIs, SNRIs, etc. are not
What should your LAST choice be for a drug for MDD or PDD if all other choices fail? Why?
MAOI - basically these suck. You have to be on a tyramine free diet (no wine, beer, cheese, aged foods, smoked meats, WTF) or else you could go into a hypertensive crisis.
What happens if a patient takes an MAOI + SSRI?
Serotonin syndrome
What happens if a patient takes an MAOI with a TCA?
Delirium and HTN
Why don’t we like MAOIs again?
Cause you can’t eat any fun food and they have lots of risks and side effects – AVOID (says green PANCE)
