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BM: Unit 2 > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

Define bipolar disorder

A
  1. Bipolar Disorder is generally characterized by sustained mania spells and sustained depressive spells.
  2. Bipolarity is not rapid mood swings hourly or daily
  3. Bipolar is often a life long and recurring illness that can be mild, moderate, or severe in nature
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2
Q

What is the general etiology of bipolar disorder?

A

Bipolar disorder may be 50-80% genetic suggesting clear gene X environment interaction in its causation

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3
Q

What are the DSM-V criteria for Mania?

A
  1. Distinct, abnormal, elevated, expansive (or irritable mood) x 7 days minimum.
  2. At least 3 symptoms must be present for at least 1 week:
    A. Increased self esteem/grandiosity
    B. Decreased sleep
    C. Increased speech
    D. Racing thoughts
    E. Distractibility
    F. *Increased activity (and energy is key for DSM 5)
    G> Increased dangerous impulsivity
  • Must cause distress/dysfunction
  • *Cannot be due to another disorder, medical condition, substance misuse
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4
Q

What does DTRHIGH stand for?

A
  1. Distractible
  2. Talkative
  3. Racing thoughts
  4. Hyperactive
  5. Impulsive
  6. Grandiose
  7. Hyposomnic
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5
Q

What is hypomania?

A
  1. Milder mania
  2. At least 4 days or more
  3. Same symptoms as mania
  4. The symptoms provide an unequivocal change in function, personality… that is clearly noted by others
  5. Not severe enough to cause marked impairment
  • Must cause distress/dysfunction
  • *Cannot be due to another disorder, medical condition, substance misuse
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6
Q

Define major depressive episode (MDE)

A
  1. Pervasive sad, down, or irritable mood
  2. > 2 weeks, 5 out 9 SIGECAPS NEEDED
    * Must cause distress/dysfunction
    * *Cannot be due to another disorder, medical condition, substance misuse
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7
Q

What is a mixed episode?

A

Meets criteria for both a manic episode and a major depressive episode

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8
Q

What is bipolar 1?

A
  1. Mania/mixed episode and +/- MDE
  2. Must have mania, do not need to have depression
  3. Classic
  4. Men and women equal
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9
Q

What is bipolar 2?

A
  1. Depressive and hypomanic episodes
  2. Must have hypomania, do not need to have depression
  3. W>M
  4. Bipolar II can turn into bipolar I if they hit a full manic episode
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10
Q

What is cyclothymia?

A
  1. > 2 years hypomania (persistent) with minor depressions
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11
Q

What other characteristics are asst. with bipolar disorder?

A
  1. Increase sexual activity
  2. Increase in seductive, flashy dress with increased accessorizing
  3. Increase anger and escalation
  4. Increase energy, able to work more, able to be more creative, think out of the box, take chances
  5. Can become psychotic
    A. Delusions
    B. Hallucinations
    C. Thought disorder
  6. Greater likelihood of job loss, divorce, legal issues
  7. Spend more time depressed rather than manic
  8. Depressed phase actually more disabling, but manic phase more catastrophic
  9. Often takes a decade and 4 doctors to obtain correct diagnosis
  10. About half of patients do not remember/or report previous mania when asked
  11. Avg patient spends 6 months euthymic (normal mood)
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12
Q

What biological factors are involved in the etiology of bipolar disorder?

A
  1. Altered neurotransmitter activity (Increase of DA, SR, NE)
  2. Monoamine Receptor Deficiency theory (opposite of depression)
    Genetics (high association)
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13
Q

What is the kindling hypothesis?

A
  1. Too much neuronal limbic firing

2. Seizure and anti-epilepsy drug model via Na++ channel blockade

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14
Q

What psychosocial factors are involved in the etiology of bipolar disorder?

A
  1. Low self esteem, negative outlook, Learned helplessness, Catastrophic loss, demeaning parents, peers -> can yield denial and fantasy defenses to occur = mania
  2. Stress can increase mania despite what book says
    A. Stress can lower compliance
    B. Disrupted sleep and circadian rhythm
    C. Increase substance abuse
    -Triggered by antidepressants, stimulants, steroids, illegal uppers
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15
Q

When should antidepressants be used for bipolar?

A
  1. Try not to use them.
  2. Avoid antidepressants that increase multiple monoamine neurotransmitters (TCA, MAOi)
  3. Favor lower doses of much simpler mechanistic SSRI(selective serotonin reuptake inhibitors)
    A. If you have to use them, make sure a mood stabilizer is used first to help prevent antidepressant alone from causing increased mania and instability
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16
Q

Why are antipsychotics used for bipolar?

A
  1. Mania Mechanisms?
    A. They block the dopamine-2 receptor which treats mania or helps prevent it
  2. Antidepression Mechanisms?
    A. All block 5HT2a receptors which treats depression
    B. Some stimulate 5HT1a receptors “ “ “ “
    C. Some have SSRI properties
    D. Some have NRI properties
    E. Some block 5HT2c, 5HT3, 5HT7 all of which have antidepressant inklings

THEY ARE UNIQUELY SUITED TO TREAT BOTH SIDES OF BIPOLARITY

17
Q

What antidepressants are approved for bipolar disorder?

A
  1. Olanzapine + fluoxetine
  2. Quetiapine (XR)
    Lurasidone
18
Q

What are the SE of antidepressant meds?

A
  1. All antipsychotics risk tardive dyskinesia, dystonia, akathisia, parkinsonism, neurleptic malignant syndrome, agranulocytosis, risk of diabetes, hypercholesteremia, hypertension (Metabolic Syndrome)
  2. Day to day side effects typically include fatigue, somnolence, dizzyness, headache
19
Q

What mood stabilizers are used for bipolar disorder?

A
  1. Lithium- provides Ca++ membrane stability and promotes neuronal health and protective factors
    A. Risks polyurea, polydipsia, GI distress, renal dysfuction, hypothyroidism, lymphocytosis, hyperparathyroidism, psoriasis, cardiac arrythmia
  2. Divalproex- increases GABA activity/tone
    A. Risks sedation, weight gain, hair loss, GI distress, pancreatitis, hepatitis, thrombocytopenia, polycystic ovaries
  3. Lamotrigine- Approved for Maintenance
    A. Risks sedation, tremor, ataxia, dysarthria, stevens-johnson rash
  4. Carbamazepine- blocks Na+ channels and promotes neuronal health…
    A. Risks sedation, tremor, ataxia, dysarthria, aplastic anemia
  5. Risperidone, Aripiprazole
  6. Olanzapine, Asenapine
  7. Quetiapine
20
Q

When does psychotherapy work for bipolar disorder?

A
  1. Works for the depressed phase

2. Does not work for the manic phase

BM: Unit 2 (7 decks)

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