Bipolar Disorder Flashcards
describe bipolar 1
manic episode with or without depression
describe bipolar 2
at least 1 hypomanic episode + at least 1 major depressive episode
what is the biggest RF for bipolar disorder
family history
onset of bipolar is usually in
late adolescence and young adulthood
what % of those with bipolar disorder are unable to maintain a proper work role?
30%
describe mania
period of being “high” for at least 1 week, present most of the day + nearly every day
or any duration if hospitalized
in mania, ___ of the following sx ( __ if mood is only irritable) are present
3
4 if only irritable
give 3 sx of mania
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)
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
mania
The episode is not severe enough to cause marked impairment in social/ occupational functioning or to necessitate hospitalization
describes
hypomania
if a person with bipolar disorder has hallucinations, this is
1. bipolar 1
2. bipolar 2
1
psychotic features = automatically manic episode
describe hypomania
feeling “high” for at least 4 consecutive days + most of the day nearly every day
an MDE is when ___ or more sx are present during the same __ period
5 or more sx
2 week period
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
1
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
2
which of the following has earlier onset and multiple prior episodes
1. bipolar depression
2. unipolar depression
1
which of the following has onset >25yrs and long durations >6mths of each episode
1. bipolar depression
2. unipolar depression
2
what is bipolar disorder with mixed features?
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)
what is bipolar disorder with rapid cycline?
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)
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)
4 mood episodes in last 12mths
2 mths
cyclothymic disorder is
for the last 2 yrs, many episodes that do not meet the criteria for hypomanic or depressive
(1yr if adolescent)
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
half the time
2 months
list the classes of mood stabilizers
lithium
anticonvulsants
what is the most effective mood stabilizer
lithium
which of the following has antisuicidal properties
1. sodium divalproex
2. lithium
3. risperidone
4. buproprion
2
lithium level for acute tx
0.8-1.2mmol/L
maintenance tx lithium levels
0.6-1.2
what dose should lithium be initiated at
100mg PO qhs
what is a typical dose of lithium
900-1200mg/d in divided doses or once daily
lithium acute SEs
GI upset, tremor, polyuria, polydipsia
lithium chronic SEs
weight gain, hypothyroidism, renal
which lab values can lithium change? (5)
increases WBCs, QTc interval, levels of Ca2+, weight gain
hypothyroidism
with lithium, measure first plasma lvl______after starting tx, then once qwk F2wks until levels stable, thereafter at clinical discretion
5days
what are sx of mild lithium toxicity
Develops over several days: ataxia, coarse tremor, confusion, diarrhea, drowsiness, fasiculation, slurred speech
May occur with levels at normal range
what levels are mild lithium toxicity?
1.5-2mmol/L
sometimes at normal lvls (0.8-1.2)
what level is mod/severe lithium toxicity
> 2mmol/L
blood lithium levels may be reduced by (3)
forced alkaline diuresis
peritoneal dialysis
hemodialysis
convulsions from lithium OD controlled by
BZDs
list 3 drugs that can increase lithium levels
ACEis, ARBs, CBZ, CCBs, diuretics, fluoxetine, metronidazole, NSAIDs, sodium depletion, spironolactone
list 3 drugs that can decrease lithium levels
caffeine, NaCl, theophylline, topiramate
how should lithium be tapered down
gradual d/c over 2-4wks
too rapid of lithium d/c may result in sx of
anxiety, instability, emotional lability
should anticonvulsant levels be measured in mood stabilization
no- but can inform on adherence, target, SEs
which anticonvulsants may be used for bipolar disorder
divalproex
valproic acid
carbamazepine
lamotrigine
which 3 anticonvulsants should not be used for bipolar disorder
gabapentin, pregabalin, topiramate
antipsychotics are
1. more antimanic
2. more antidepressive
3. prevents swinging from manic to depression
4. for schizoaffective more than bipolar
1
which AP orals are approved for bipolar depression
lurasidone, quetiapine
which AP LAIs are approved for bipolar
risperidone and aripiprazole
which AP LAI is approved for schizoaffective disorder
paliperidone
when should lithium be used over divalproex
Classical euphoric grandiose mania
Few prior episodes of illness
Mania-depression-euthymia course
famHx BPD- esp those with FHx of lithium response
when is divalproex preferred over lithium
Predominant irritable or dysphoric mood
Multiple prior episodes
Comorbid substance use, anxiety
hx head trauma
tx with AD only in BPD risks
cycle acceleration
in bipolar 1 ____ and ____ (AD) can be used 2nd lien in conjunction wtih mood stabilizers
SSRIs (except paroxetine)
buproprion
which 2 AD may be used in bipolar 2 as monotx
sertraline and venlafaxine- 2nd line
what is diurnal stability
adequate sleep, healthy diet, avoid substance/ caffeine/ nicotine/ alcohol use
8 options in 1st line tx for acute mania
lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone (>6mg), risperidone, cariprazine
1st line combo tx for acute mania
quetiapine/ aripiprazole/ risperidone/ asenapine + LI/DVP
T or F: most bipolar pts stay on monotx entire lives
F- may require short/ LT combo tx to address acute/ subsyndromal sx + to reduce rates of recurrence
lamotrigine is better in bipolar pts with
1. predominantly depressive sx
2. predominantly manic sx
3. anxiety comorbidity
4. 1+3
5. 2+3
4
3 medications for maintenance tx in bipolar disorder
lithium
quetiapine
lamotrigine
describe schizoaffective disorder
disorder with psychotic + affective (manic/ depressive) sx
T or F: there are no tx guidelines for SZA
T
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
3
which 2 do not offer benefit in SZA
1. paliperidone
2. clozapine
3. quetiapine
4. BZDs
5. olanzapine
quetiapine and BZDs
