Bipolar Disorder Flashcards
What is necessary for a bipolar diagnosis?
you have to have a history of manic episode or hypomanic episode - depression might or not be present in history
What’s the time frame for a bipolar 1 diagnosis?
you have to have mania (elevated, espansive, irritable mood) for a DISTINCT period lasting one week or more (plus 3 or more other symptoms)
How do you differentiate mania and hypomania/
in hypomania they can no longer function in work or relationships - in hypomania they can
If a mania appears to be antidepressant-induced, what is necessary for you to consider it an actual mania for a bipolar diagnosis?
it has to continue after the antidepressant is stopped
True or false: after a manic episode ends, there is usually residual symptoms in bipolar disorder.
false - there’s inter-episode clearing, which is what makes it different from mania in schizophrenia
What is the monozygotic twin concordance for bipolar?
80%!
What is the prevalence of BD in the general population?
.4-.8%
What is the typical time frame for mania? For major depression?
mania: 1 week to 6 months in episode duration
major depression: 4 weeks to 2 years in episode duration
IN mania, what neuroanatomical structures are deactivated?
inferior frontal cortex and ventrolateral prefrontal cortex
What system is hyperactive in peopl in mania?
limbic system
What is the suicide rate in those with bipolar disorder? higher or lower than major depression?
over 10%
higher than major depression (less than 2 %)
What are the only two pharmacological agents that have been proven to have anti-suicide effects?
clozapine and lithium
What symptoms/criteria can differentiate bipolar from ADHD?
elated mood, grandiosity, flight of ideas, decreased NEED for sleep (not just insomnia), hypersexuality
What cluster of personality disorders can be confused for bipolar disorder?
cluster b (the wild)
How can you differentiate a personality disorder from BD?
with a personality disorder, the mania or whatever symptom will just be a worse continuation of a chronic problem, whereas with bipolar disorder the mania has to be a discrete change from baseline behavior
What are the 3 distinct purposes to psychopharmacology with bipolar disorder?
- treat/prevent depression
- treat/prevent mania
- manage impulsivity/emotional lability/irrespective of diagnosis and risks
If bipolar disorder is high on your differential, what type of history would still make it ok to try an antidepressant as a monotherapy?
only in patients that don’t have a clear history of mania - if they do, do NOT give them an antidepressant unless they’re also on a mood stabilizer
What is activation syndrome?
it’s a side effect reaction to antidepressants - includes agitation, anxiety, irritability, akathisia, etc.
What are the 3 major mood stabilizers we tend to use for bipolar?
- lithium
- divalproex sodium (depakote0
- Carbamazepine (tegretol)
If you put a patient on lithium, what labs do you need to repeatedly check?
- general lithium levels - there’s a narrow TI, so toxicity is an issue
- check for hypothyroidism
- check for renal insufficiency
If you put a patient on depakote, what labs do you need to repeatedly check?
check for hepatotoxicity and thrombocytopenia
What do you need to check for with labs with carbamazepine/
agranulocytosis and hepatotoxicity
What is the risk of neuroleptic treatment in children?
diabetes and neuroleptic malignant syndrome - it’s a potentially fatal condition with loss of body temp regulation, renal and respiratory failure, ANS impairment and LOC
What is appropriate for treatment of acute mania according to the TX medication algorithm project?
monotherapy with a mood stabilizer like lithium, valproate, or carbamazepine (Sutherland also likes to use a neuroleptic temporarily)
What so the later stages of the TX med algorithm do for BD?
clozapine and ECT
