Bipolar Disorder

Question 0

Bipolar 2

Answer 0

refers to patients w/ history of hypomania and major depressive disorders
-more common in woman than in men

Question 1

Bipolar I

Answer 1

refers to patients who have had at least one episode of mania
-bipolar disorder mainly starts w/ depression

Question 2

rapid cycling

Answer 2

when 4+ episodes of illness occur w/in a 12-month period. Some may experience multiple episodes in a single week, or even a single day
-more common in women than men

Question 3

Cyclothymia

Answer 3

patients w/ chronic (2 yrs.) mood swings that fluctuate btwn hypomania and minor but not major depression.
-milder form of Bipolar disorder

Question 4

Criteria for Mani Episode (DIG FAST)

Answer 4

1. distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 WEEK.
2. during the period of mood disturbance, 3+ symptoms have persisted and are present
   Distractibility & easily frustrated
   Irresponsibility- excessive involvement in pleasurable activities w/ high potential for painful consequences
   Grandiosity or inflated self-esteem
   Flight of ideas or feeling that thoughts are racing
   Activity that is goal-oriented
   Sleep need is decreased
   Talkative, pressured speech
3. mood disturbance is sufficiently sever to cause marked impairment in occupational functioning or in social activities and relationships w/ others, to need hospitalization to prevent harm from self or others, psychotic features

Question 5

Criteria for Hypomanic Episode

Answer 5

1. distinct period of persistently elevated, expansive, or irritable mood, lasting throughout 4 DAYS, that is clearly different from usual non depressed mood.
2. 3+ of these s/s
   Distractibility & easily frustrated
   Irresponsibility- excessive involvement in pleasurable activities w/ high potential for painful consequences
   Grandiosity or inflated self-esteem
   Flight of ideas or feeling that thoughts are racing
   Activity that is goal-oriented
   Sleep need is decreased
   Talkative, pressured speech
   3.unequivocal change in functioning that is uncharacteristic person when not symptomatic
3. observed by others
4. not severe
5. not d/t direct effects of substance or general medical condition

Question 6

does rate of cycling increase w/ each episode?

Answer 6

YES; manic episode= 4 months, depressive= 6-9 months

-as disorder progresses, usually a decrease in amount of time between episodes

Question 7

Comorbidity w/ Bipolar Disorder

Answer 7

Substance Abuse: 60%
Anxiety
Psychotic Symptoms: 50%

Question 8

Tx:Bipolar Disorder

Answer 8

Mood stabilizers: Lithium Carbonate (Eskalith, Lithobid, Lithonate, Eskalith CR) -have “lith in the name”
Anticonvulsants: valproic acid (Depakene, depakote), carbamazepine (Tegretol)

Question 9

side effect/adverse drug reactions to Lithium

-to anticonvulsants

Answer 9

-GI distress, weight gain, fine tremor, cognitive impairment, polyuria, hypothyroidism, cardiovascular side effects
lithium toxicity- reduced salt intake, reduced fluid intake: N/V, slurred speech, confusion, arrhythmia
-Tegretol- Gi complaint, CNS, Hematological, Hepatic
-Depakote- SEDATION & GI distress, pacreatitis, heaptitis, hematological, neurological, overdose- somnolence, heart block, coma