Bipolar Disorder Flashcards
How is bipolar disorder categorized?
It is characterized by fluctuations in mood from an extremely sad or hopeless state to an abnormally elevated, overexcited or irritable mood called mania or hypomania (a milder form fo mania). Each mood episode represents a drastic change from an individual’s symptoms of both mania and depression
How is bipolar disorder classified?
Bipolar disorder is classified as bipolar I or bipolar II, which differ primarily by the severity of mania experienced
What is cyclothymia?
Cyclothymia is a related disorder consisting of periods of hypomanic and depressive symptoms without meeting criteria for a major depressive, manic or hypomanic episode
What are some possible complications of bipolar disorder?
Bipolar disorder can reduce quality of life or cause problems with relationships and employment. It can also lead to drug abuse, anxiety disorders and suicide
What is the definition of mania?
Abnormally elevated or irritable mood for at least a week (or any duration if hospitalization is needed)
What are the symptoms of mania?
- Inflated self-esteem
- Needs less sleep
- More talkative than normal
- Jumping from topic to topic
- Easily distracted
- Increase in goal-directed activity
- High-risk, pleasurable activities (e.g. buying sprees, sexual indiscretions, gambling)
How do you diagnose mania?
Exhibits > 3 symptoms (if mood is only irritable, exhibits > 4 symptoms)
Describe Bipolar I
At least one episode of mani, and usually, bouts of intense depression (a depresssive episode is not required for diagnosis). Mania is associated with at least one of the following: significant impairment in social/work functioning, psychosis/delusions or requires hospitalization
Describe Bipolar II
At least one episode of hypomania (lasting > 4 consecutive days) and at least one depressive episode (lasting > 2 weeks). Hypomania does not affect social/work functioning, does not causes psychosis nor require hospitalization
What is the definition of bipolar depression?
Predominant symptoms of depressive episode include feelings of sadness or depressed mood and/or loss of interest in previously enjoyed activities
What is the definition of psychosis?
Severe mental condition where there is a loss of contact with reality, involves abnormal thinking and perception (e.g. hallucinations and delusions)
How do you diagnose bipolar disorder?
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria are used to diagnose bipolar disorders
*A toxicology screen should be done prior to starting treatment ot rule out drug-induced mania
What is the goal of treatment of patients with bipolar disorder?
The goal of treatment is to stabilize the mood without inducing a depressing or manic state
Which medications can treat both mania and depression without inducing either state?
The traditional mood stabilizers, such as lithium and antiepileptic drugs (valproate, lamotrigine and carbamazepine), treat both mania and depression without inducing either state
Which medications can be used toe help stabilize the mood when mania occurs with psychosis?
Antipsychotics
When can antidepressants be used for the treatment of bipolar disorder?
Antidepressants can induce or exacerbate a manic episode when used as monotherapy, so they should only be used inc combination with a mood stabilizer
How do you select a treatment for bipolar disorder?
- The side effect profile of the drug
- The patient’s medication history and first-degree relatives’ medication history; if the patient or a family member responded well to a drug, the same drug might be a reasonable option
- The drug formulations available and cost
What is the acute treatment for a manic episode?
First-line treatment is valproate, lithium or an antipsychotic. A combination of an antipsychotic + lithium or valproate is preferred for severe episodes
What is the acute treatment of a depressive episode?
First-line treatment is lithium, but lamotrigine can be used as an alternative
What are maintenance medications that can be used for bipolar disorder?
Lithium and valproate are preferred for maintenance monotherapy, but lamotrigine, carbamazepine and second-generation antipsychotics are alternatives. Antipsychotics or antidepressants may be added to lithium or valproate for maintenance therapy
What is required with all antidepressants and with all antipsychotics?
MedGuides
Why is treating bipolar disease in pregnancy complex?
Common mood stabilizers are teratogenic
What can valproate exposure do in pregnancy?
Valproate exposure in pregnancy can increase the risk of fetal anomalies, including neural tube defects, fetal valproate syndrome and long-term adverse cognitive effects. Avoid in pregnancy, if possible, especially during the first trimester
What can carbamazepine exposure do in pregnancy?
Carbamazepine exposure in pregnancy can cause fetal carbamazepine syndrome, which can result in facial abnormalities and other significant issues. Avoid in pregnancy, if possible, especially during the first trimester
