Bipolar Disorder

Question 1

What is necessary for a bipolar diagnosis?

Answer 1

you have to have a history of manic episode or hypomanic episode - depression might or not be present in history

Question 2

What’s the time frame for a bipolar 1 diagnosis?

Answer 2

you have to have mania (elevated, espansive, irritable mood) for a DISTINCT period lasting one week or more (plus 3 or more other symptoms)

Question 3

How do you differentiate mania and hypomania/

Answer 3

in hypomania they can no longer function in work or relationships - in hypomania they can

Question 4

If a mania appears to be antidepressant-induced, what is necessary for you to consider it an actual mania for a bipolar diagnosis?

Answer 4

it has to continue after the antidepressant is stopped

Question 5

True or false: after a manic episode ends, there is usually residual symptoms in bipolar disorder.

Answer 5

false - there’s inter-episode clearing, which is what makes it different from mania in schizophrenia

Question 6

What is the monozygotic twin concordance for bipolar?

Answer 6

80%!

Question 7

What is the prevalence of BD in the general population?

Answer 7

.4-.8%

Question 8

What is the typical time frame for mania? For major depression?

Answer 8

mania: 1 week to 6 months in episode duration

major depression: 4 weeks to 2 years in episode duration

Question 9

IN mania, what neuroanatomical structures are deactivated?

Answer 9

inferior frontal cortex and ventrolateral prefrontal cortex

Question 10

What system is hyperactive in peopl in mania?

Answer 10

limbic system

Question 11

What is the suicide rate in those with bipolar disorder? higher or lower than major depression?

Answer 11

over 10%

higher than major depression (less than 2 %)

Question 12

What are the only two pharmacological agents that have been proven to have anti-suicide effects?

Answer 12

clozapine and lithium

Question 13

What symptoms/criteria can differentiate bipolar from ADHD?

Answer 13

elated mood, grandiosity, flight of ideas, decreased NEED for sleep (not just insomnia), hypersexuality

Question 14

What cluster of personality disorders can be confused for bipolar disorder?

Answer 14

cluster b (the wild)

Question 15

How can you differentiate a personality disorder from BD?

Answer 15

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

Question 16

What are the 3 distinct purposes to psychopharmacology with bipolar disorder?

Answer 16

1. treat/prevent depression
2. treat/prevent mania
3. manage impulsivity/emotional lability/irrespective of diagnosis and risks

Question 17

If bipolar disorder is high on your differential, what type of history would still make it ok to try an antidepressant as a monotherapy?

Answer 17

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

Question 18

What is activation syndrome?

Answer 18

it’s a side effect reaction to antidepressants - includes agitation, anxiety, irritability, akathisia, etc.

Question 19

What are the 3 major mood stabilizers we tend to use for bipolar?

Answer 19

1. lithium
2. divalproex sodium (depakote0
3. Carbamazepine (tegretol)

Question 20

If you put a patient on lithium, what labs do you need to repeatedly check?

Answer 20

1. general lithium levels - there’s a narrow TI, so toxicity is an issue
2. check for hypothyroidism
3. check for renal insufficiency

Question 21

If you put a patient on depakote, what labs do you need to repeatedly check?

Answer 21

check for hepatotoxicity and thrombocytopenia

Question 22

What do you need to check for with labs with carbamazepine/

Answer 22

agranulocytosis and hepatotoxicity

Question 23

What is the risk of neuroleptic treatment in children?

Answer 23

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

Question 24

What is appropriate for treatment of acute mania according to the TX medication algorithm project?

Answer 24

monotherapy with a mood stabilizer like lithium, valproate, or carbamazepine (Sutherland also likes to use a neuroleptic temporarily)

Question 25

What so the later stages of the TX med algorithm do for BD?

Answer 25

clozapine and ECT