Bipolar Disorder

Question 1

Bipolar DSM Criteria

Answer 1

D - Distractible
I - Injudicious
G - Grandiose
F - Fast thoughts
A - Activity increased
S - Sleep reduced
T - Talking rapidly

MANIA = 3 sx + euphoria OR 4 sx + irritability for 1wk or longer (or hospitalization) WITHOUT substance use

Question 2

Hypomania

Answer 2

Same criteria as mania, but without significant distress or impairment
Lasts less that 4 days

Question 3

Bipolar I v Bipolar II

Answer 3

Bipolar I - just mania

Bipolar II - mania/hypomania & depression

Question 4

Cyclothymia

Answer 4

2+ years of most days with some depressive/hypomanic sx

< 2mo of euthymia

Never full depressive/manic episodes

Question 5

Prevalence if psychotic symptoms

Answer 5

50%

Question 6

Hypomania screening questions

Answer 6

Sex
Sleep
Speeding
Spending
Special Projects

Question 7

Epidemiology

Answer 7

Males = Females

3% prevalence

Question 8

Bipolar Age of Onset

Answer 8

Peak age of onset 15-19 (Second peak ~50y/o)

1/3 pts have sx before 13y/o

Question 9

Bipolar Comorbidities

Answer 9

19% suicide rate (lower if never hospitalized)
60% Substance misuse comorbidity
>50% anxiety DO comorbidity

Question 10

Childhood v. Adult

Answer 10

< 12y/o: 80% with rapid cycling

> 13y/o: 60% mixed, chronic

Question 11

Prognosis

Answer 11

1/3 complete recovery w/ mood stabilizer monotherapy

2/3 require polypharmacy

1/4 do not recover (rapid cycling, 4+ episodes/yr)

Question 12

Predictors of Poor Outcome

Answer 12

Substance misuse
Psychosis
Early onset
Predominant depression
Repeated episodes
Mixed states

Question 13

Predictors of Good Outcome

Answer 13

Euphoric mania
Unipolar mania
Late onset

Question 14

Bipolar Treatment

Answer 14

Mood stabilizer (prophylaxis & acute)
Combination w/ antipsychotic (atypical)
CBT

NO antidepressants - can trigger manic episode

Question 15

Mood Stabilizers

Answer 15

Lithium
Valporate / valproic acid
Carbamazepine
Oxcarbazepine
Lamotrigine