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445- Pain and Mental Health > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

describe bipolar 1

A

manic episode with or without depression

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2
Q

describe bipolar 2

A

at least 1 hypomanic episode + at least 1 major depressive episode

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3
Q

what is the biggest RF for bipolar disorder

A

family history

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4
Q

onset of bipolar is usually in

A

late adolescence and young adulthood

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5
Q

what % of those with bipolar disorder are unable to maintain a proper work role?

A

30%

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6
Q

describe mania

A

period of being “high” for at least 1 week, present most of the day + nearly every day
or any duration if hospitalized

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7
Q

in mania, ___ of the following sx ( __ if mood is only irritable) are present

A

3
4 if only irritable

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8
Q

give 3 sx of mania

A

Inflated self esteem or grandiosity
Decreased need for sleep
Flight of ideas/ subjective experience that thoughts are racing
↑ talkative than usual/ pressure to keep talking
Distractibility
↑ in goal directed activity (social, at work, school, sexually) or psychomotor agitation (purposeless nongoal directed activity)
Excessive involvement in activities that have a high potential for painful consequences (ex- unprotected sex, excessive shopping)

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9
Q

The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning/ to necessitate hospitalization to prevent harm to self/ others, or there are psychotic features
describes

A

mania

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10
Q

The episode is not severe enough to cause marked impairment in social/ occupational functioning or to necessitate hospitalization
describes

A

hypomania

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11
Q

if a person with bipolar disorder has hallucinations, this is
1. bipolar 1
2. bipolar 2

A

1
psychotic features = automatically manic episode

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12
Q

describe hypomania

A

feeling “high” for at least 4 consecutive days + most of the day nearly every day

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13
Q

an MDE is when ___ or more sx are present during the same __ period

A

5 or more sx
2 week period

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14
Q

a pt presents with hypersomnia and increased weight. they say they think slower but are also very guilty about not completing their work. They’ve started napping more. this is
1. bipolar deprsesion
2. unipolar depression

A

1

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15
Q

initial insomnia/ reduced sleep
Appetite and/or weight loss
Normal or increased activity levels
Somatic complaints

the sx above are described by
1. bipolar depression
2. unipolar depression

A

2

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16
Q

which of the following has earlier onset and multiple prior episodes
1. bipolar depression
2. unipolar depression

A

1

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17
Q

which of the following has onset >25yrs and long durations >6mths of each episode
1. bipolar depression
2. unipolar depression

A

2

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18
Q

what is bipolar disorder with mixed features?

A

manic or hypomanic episodes occurring at the same time as ≥ 3 sx of depression, or vice versa (depressive episode occurring at same time as ≥ 3 sx of mania/ hypomania)

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19
Q

what is bipolar disorder with rapid cycline?

A

presence of at least 4 mood episodes in prev 12 mths that meet the criteria for manic, hypomanic, or major depressive episode
Episodes are separated by either partial or full remissions of at least 2 mths or a switch to an episode of the opposite polarity (ex- MDE to manic)

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20
Q

bipolar with rapid cycling: presence of at least ___mood episodes in prev __ mths that meet the criteria for manic, hypomanic, or major depressive episode
Episodes are separated by either partial or full remissions of at least_____or a switch to an episode of the opposite polarity (ex- MDE to manic)

A

4 mood episodes in last 12mths
2 mths

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21
Q

cyclothymic disorder is

A

for the last 2 yrs, many episodes that do not meet the criteria for hypomanic or depressive

(1yr if adolescent)

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22
Q

in cyclothymic disorder, in the 2 year period, the hypomanic and depressive periods have been present for at least__________ + individual has not been without the sx for more than _____ at a time

A

half the time
2 months

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23
Q

list the classes of mood stabilizers

A

lithium
anticonvulsants

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24
Q

what is the most effective mood stabilizer

A

lithium

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25
Q

which of the following has antisuicidal properties
1. sodium divalproex
2. lithium
3. risperidone
4. buproprion

A

2

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26
Q

lithium level for acute tx

A

0.8-1.2mmol/L

27
Q

maintenance tx lithium levels

A

0.6-1.2

28
Q

what dose should lithium be initiated at

A

100mg PO qhs

29
Q

what is a typical dose of lithium

A

900-1200mg/d in divided doses or once daily

30
Q

lithium acute SEs

A

GI upset, tremor, polyuria, polydipsia

31
Q

lithium chronic SEs

A

weight gain, hypothyroidism, renal

32
Q

which lab values can lithium change? (5)

A

increases WBCs, QTc interval, levels of Ca2+, weight gain
hypothyroidism

33
Q

with lithium, measure first plasma lvl______after starting tx, then once qwk F2wks until levels stable, thereafter at clinical discretion

A

5days

34
Q

what are sx of mild lithium toxicity

A

Develops over several days: ataxia, coarse tremor, confusion, diarrhea, drowsiness, fasiculation, slurred speech
May occur with levels at normal range

35
Q

what levels are mild lithium toxicity?

A

1.5-2mmol/L
sometimes at normal lvls (0.8-1.2)

36
Q

what level is mod/severe lithium toxicity

A

> 2mmol/L

37
Q

blood lithium levels may be reduced by (3)

A

forced alkaline diuresis
peritoneal dialysis
hemodialysis

38
Q

convulsions from lithium OD controlled by

A

BZDs

39
Q

list 3 drugs that can increase lithium levels

A

ACEis, ARBs, CBZ, CCBs, diuretics, fluoxetine, metronidazole, NSAIDs, sodium depletion, spironolactone

40
Q

list 3 drugs that can decrease lithium levels

A

caffeine, NaCl, theophylline, topiramate

41
Q

how should lithium be tapered down

A

gradual d/c over 2-4wks

42
Q

too rapid of lithium d/c may result in sx of

A

anxiety, instability, emotional lability

43
Q

should anticonvulsant levels be measured in mood stabilization

A

no- but can inform on adherence, target, SEs

44
Q

which anticonvulsants may be used for bipolar disorder

A

divalproex
valproic acid
carbamazepine
lamotrigine

45
Q

which 3 anticonvulsants should not be used for bipolar disorder

A

gabapentin, pregabalin, topiramate

46
Q

antipsychotics are
1. more antimanic
2. more antidepressive
3. prevents swinging from manic to depression
4. for schizoaffective more than bipolar

A

1

47
Q

which AP orals are approved for bipolar depression

A

lurasidone, quetiapine

48
Q

which AP LAIs are approved for bipolar

A

risperidone and aripiprazole

49
Q

which AP LAI is approved for schizoaffective disorder

A

paliperidone

50
Q

when should lithium be used over divalproex

A

Classical euphoric grandiose mania
Few prior episodes of illness
Mania-depression-euthymia course
famHx BPD- esp those with FHx of lithium response

51
Q

when is divalproex preferred over lithium

A

Predominant irritable or dysphoric mood
Multiple prior episodes
Comorbid substance use, anxiety
hx head trauma

52
Q

tx with AD only in BPD risks

A

cycle acceleration

53
Q

in bipolar 1 ____ and ____ (AD) can be used 2nd lien in conjunction wtih mood stabilizers

A

SSRIs (except paroxetine)
buproprion

54
Q

which 2 AD may be used in bipolar 2 as monotx

A

sertraline and venlafaxine- 2nd line

55
Q

what is diurnal stability

A

adequate sleep, healthy diet, avoid substance/ caffeine/ nicotine/ alcohol use

56
Q

8 options in 1st line tx for acute mania

A

lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone (>6mg), risperidone, cariprazine

57
Q

1st line combo tx for acute mania

A

quetiapine/ aripiprazole/ risperidone/ asenapine + LI/DVP

58
Q

T or F: most bipolar pts stay on monotx entire lives

A

F- may require short/ LT combo tx to address acute/ subsyndromal sx + to reduce rates of recurrence

59
Q

lamotrigine is better in bipolar pts with
1. predominantly depressive sx
2. predominantly manic sx
3. anxiety comorbidity
4. 1+3
5. 2+3

A

4

60
Q

3 medications for maintenance tx in bipolar disorder

A

lithium
quetiapine
lamotrigine

61
Q

describe schizoaffective disorder

A

disorder with psychotic + affective (manic/ depressive) sx

62
Q

T or F: there are no tx guidelines for SZA

A

T

63
Q

which of the following is true
1. there are new guidelines for SZA tx
2. more males affected than females in SZA
3. SZA has higher rates of hospitalizations and suicide than SZ
4. SZA has more mania than SZ
5. SZ pts more likely to recieve concomitant psychotropics than SZA

A

3

64
Q

which 2 do not offer benefit in SZA
1. paliperidone
2. clozapine
3. quetiapine
4. BZDs
5. olanzapine

A

quetiapine and BZDs

445- Pain and Mental Health (21 decks)

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