Bipolar Diagnosis, Presentation, Symptoms

Question 1

Key feature of BPD

Answer 1

Cyclic, recurrent fluctuation of mood which occurs over a person’s lifetime

Question 2

Bipolar I classification

Answer 2

manic episode +/- major depressive or hypomanic episode (may be mixed)

Question 3

Bipolar II classification

Answer 3

major depressive episode with hypomanic episode

Question 4

Common characteristics of BPD

Answer 4

<25 years old
family history
increased sleeping/napping
increased appetite/weight
psychomotor retardation
atypical depression
co-occurring substance use

Question 5

Mania vs. hypomania

Answer 5

Mania is >1 week period of abnormal and persistent elevated mood

Hypomania is ≥4 days of abnormal and persistent elevated mood

Question 6

Rapid cycling definition

Answer 6

> 4 episodes/year, often with key features of frequent and severe episodes of depression

Question 7

The problem with rapid cycling

Answer 7

Each episode becomes more difficult to treat and has a poor prognosis; often requires combination therapy

Question 8

Challenges to BPD diagnosis

Answer 8

MUST rule out organic causes of mania or depression

Diagnosis accuracy is key and requires a good history

Mania may be confused with ADHD-related disorders (infection, endocrine, electrolytes, CNS are others)

Depression may appear to be unipolar

Not the result of a substance either abused or prescribed (exception if the patient’s being treated for MDD)

If only a few symptoms exist (irritability, agitation)- ADR of AD only

Psychotic symptoms associated with BP-1 generally (high highs and low lows)

Use different rating scales for diagnosis

Question 9

Secondary causes of BPD: medical conditions

Answer 9

strokes, tumors, TBI, MS, HIV, sepsis, electrolyte disturbances, endocrine or hormonal dysregulation

Question 10

How to handle BPD if it’s caused by a medical condition?

Answer 10

Treat the underlying disorder, not the BPD!

Question 11

Secondary causes of BPD: medications

Answer 11

alcohol or substance intoxication, withdrawal from drugs (BZDs, opiates, ADs), DA-potentiating agents (amphetamine, cocaine), hallucinogens, herbal products and OTC, steroids, NE potentiating/augmenting agents, unopposed AD therapy, thyroid preps, xanthines (caffeine, theophylline), OTC decongestants and weight loss products