Bipolar Disorder Flashcards
Bipolar DSM Criteria
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
Hypomania
Same criteria as mania, but without significant distress or impairment
Lasts less that 4 days
Bipolar I v Bipolar II
Bipolar I - just mania
Bipolar II - mania/hypomania & depression
Cyclothymia
2+ years of most days with some depressive/hypomanic sx
< 2mo of euthymia
Never full depressive/manic episodes
Prevalence if psychotic symptoms
50%
Hypomania screening questions
Sex Sleep Speeding Spending Special Projects
Epidemiology
Males = Females
3% prevalence
Bipolar Age of Onset
Peak age of onset 15-19 (Second peak ~50y/o)
1/3 pts have sx before 13y/o
Bipolar Comorbidities
19% suicide rate (lower if never hospitalized)
60% Substance misuse comorbidity
>50% anxiety DO comorbidity
Childhood v. Adult
< 12y/o: 80% with rapid cycling
> 13y/o: 60% mixed, chronic
Prognosis
1/3 complete recovery w/ mood stabilizer monotherapy
2/3 require polypharmacy
1/4 do not recover (rapid cycling, 4+ episodes/yr)
Predictors of Poor Outcome
Substance misuse Psychosis Early onset Predominant depression Repeated episodes Mixed states
Predictors of Good Outcome
Euphoric mania
Unipolar mania
Late onset
Bipolar Treatment
Mood stabilizer (prophylaxis & acute)
Combination w/ antipsychotic (atypical)
CBT
NO antidepressants - can trigger manic episode
Mood Stabilizers
Lithium Valporate / valproic acid Carbamazepine Oxcarbazepine Lamotrigine
