Bipolar Disease

Question 1

def bipolar 1

Answer 1

> = 1 manic episodes + hypomanic/depressive episode before or after

Question 2

def bipolar 2

Answer 2

NO MANIC EPISODES
hypomanic episode and a depressive episode

Question 3

def cyclothymic disorder

Answer 3

doesn’t fit criteria for hypomanic and depressive episodes but it lasts 2Y

not often dx because these people may never seek tx

Question 4

DIG FAST criteria for manic episodes

Answer 4

elevated mood with increased energy for >= 7 days or requiring hospitalization

D - delusions
I - impulsivity
G - grandiose

F - flight of ideas
A - activity increased ➔ goal directed
S - sleep deficit
T - talkative

Question 5

criteria for hypomanic episodes

Answer 5

<=4 days but DIG FAST
no marked psychosis or impairment

Question 6

criteria for depressive episode

Answer 6

S - sleep increase
I - interest
G - guilt
E - energy decrease
C - comprehension decrease
A - appetite
P - psychomotor
S - suicidal

Question 7

general tx for bipolar

Answer 7

1. mood stabilizers ➔ lithium or valproic acid
2. consider anticonvulsants as an alternative to mood stabilizers
3. second line ➔ atypical antipsychotics

include CBT

consider ECT for refractory bipolar depression

Question 8

cx for antipsychotics

Answer 8

metabolic syndrome: increase in glucose, and cholesterol ➔ may also increase BP

can also cause drug-induced movement disorders

can also have neuroleptic malignant dsyndrome which is a medical emergency ➔ rxn vs dopamine antagonists and usually presents within the first 24h of drug initation

Question 9

how do you manage a manic episode?

Answer 9

medical emergency
requires psychiatric hospitalization

provide a calm environment
consider giving mood stabilizers, antipsychotics, and adjunctive benzodiazepines