Bipolar disorder

Question 1

Define dysthymia and hypomania

Answer 1

dysthymia and hypomania are attenuated/not as severe versions of depression and mania, respectively.

Question 2

What are the SWAG symptoms? What can they help identify.

Answer 2

Suicidality
Weight loss
Absence of pleasure in one’s usual activities
Guilt

These symptoms along with disruption in work or interpersonal relationships can help identify mood disorders (e.g. depression).

Question 3

Define bipolar disorder I and II

Answer 3

Bipolar disorder I –> mania +/- major depressive disorder

Bipolar disorder II –> hypomania +/- major depressive disorder

Question 4

List some symptoms of a manic episode

Answer 4

• inflated self-image
• excessive optimism
• increased energy and activity
• rapid thoughts and speech
• often have decreased need for sleep and decreased appetite for food
• increase appetite for sex
• uncharacteristic lack of modesty in dress and behavior
• inability to control aggressive impulses

Question 5

At least 3 of the 7 symptoms must be present for at least 2 weeks and a distinct, abnormal, elevated, expansive (or irritable mood) for 7 days minimum to be diagnosed with mania. List the possible 7 symptoms

Answer 5

1. increased self-esteem/gradiosity
2. decreased sleep
3. increased speech
4. racing thoughts
5. distractibility
6. increased activity (and energy is key)
7. increase dangerous impulsivity

Question 6

List the DTRHIGH (an acronym used to remember symptoms of mania)

Answer 6

Distractible
Talkative
Racing thoughts
Hyperactive
Impulsive
Grandiose
Hyposomnic

Question 7

Define hypomania.

Answer 7

milder mania but have similar symptoms as mania; must have symptoms for at least 4 days or more. The symptoms provide an unequivocal change in function, personality that is clearly noted by others but not severe enough to cause marked impairment.

Question 8

At least how long does a depressed person need to be ad, down or irritable to the point of causing distress/dysfunction to be diagnosed with major depressive episode?

Answer 8

at least 2 weeks

Question 9

What is cyclothymia?

Answer 9

chronic hypomania (> 2 years) in adults or at least 1 year in children + minor depression. It’s a rare spectrum of bipolar disorder

Question 10

Explain what’s happening to the levels of NTs and monoamine receptors in bipolar disorders.

Answer 10

• increase DA, 5-HT and NE

- monoamine receptors are deficient

Question 11

What is the Kindling hypothesis

Answer 11

too much neuronal firing in the limbic system.

therefore, can use anti-epilepsy meds for treating bipolar disorder.

Question 12

Explain gender prevalence differences in bipolar 1 vs bipolar 2

Answer 12

bipolar 1: women = men

bipolar 2: women > men

Question 13

How come we should try not to use antidepressants for bipolar depression? If it’s absolutely necessary, what should be given first?

Answer 13

anti-depressants will cause even more monoamine NTs, which is already a problem causing manias/hypomanias in bipolar patients.

must use mood stabilizer first to help prevent antidepressant from causing increased mania and instability

Question 14

Some atypical anti-psychotics approved for schizophrenia, have now been approved for treating bipolar depression Why?

Answer 14

They block the dopamine 2 receptor which treats mania or helps prevent it

Question 15

List some anti-manic agents (mood stabilizers) used in treating bipolar disorders

Answer 15

• lithium: provides Ca2+ membrane stability and promotes neuronal health
• divalproex: increases GABA activity/tone
• carbamazepine: blocks Na+ channels and promotes neuronal health
• atypical antipsychotics: all block D2 receptors