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BB Test 3 > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

What are the characteristics of bipolar disorder?

A
  • Cyclic mood disorder
  • Extremes of euphoria and depression during episodes
  • Mania and depression
  • May include psychosis, paranoia, hallucinations
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2
Q

What is commonly associated with bipolar disorder?

A
  • Suicide (15%)
  • Alcohol and drug addiction (50%)
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3
Q

What are the stages of mania?

A
  1. Starts pleasant (Euphoria)
  2. Irritability
  3. Paranoia (Think others are jealous of you)
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4
Q

What are common symptoms of mania?

A
  • Irritability
  • Flight of ideas (racing thoughts)
  • Distractability (poor concentration)
  • Hyperactivity
  • Increased, rapid, pressured speech
  • Decreased need for sleep - Red flag
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5
Q

Depression in bipolar disorder is (mild/severe).

A

Very severe

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6
Q

(T/F) To be diagnosed with bipolar disorder, you must have mania AND depression.

A

False. Diagnosis of bipolar disorder occur if patient ONLY has mania.

  • Depression is not a required symptom.
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7
Q

What is the average age of onset for bipolar disorder?

A

21 (college years)

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8
Q

Bipolar I is more common in males or females?

A

Neither. There is equal incidence in both males and females

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9
Q

Bipolar II is more common in males or females?

A

Females > Males

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10
Q

How do some bipolar patients act between episodes?

A
  • Many patients do very well between episodes
    • Hypomania may be helpful in work
    • Psychotic mania predicts poor outcome
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11
Q

Depression in bipolar disorder is usually (acute/chronic).

A

Chronic (can be very severe)

  • Substance abuse (alcohol and drugs) worsens course
  • Suicide in 15% of patients with depression
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12
Q

What is secondary mania?

A

Mania induced from:

  • Drugs (dopamine agonist - cocaine, antidepressants, amphetamines)
  • Medical conditions (brain trauma, HIV, stroke, MS, epilepsy, brain tumor)
  • Medications (steroids - anabolic or glucocorticoids)
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13
Q

What is the cause of early onset mania?

A

Idiopathic bipolar disorder

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14
Q

What is the cause of mania onset after 40 years old?

A

Usually a medical condition or drugs/medications

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15
Q

What are some things that cause mania to precipitate?

A
  • Post-partum state
  • Sleep deprivation
  • Dopamine agonist (amphetamines/L-dopa)
  • Antidepressants
  • Stroke or brain injury
  • Jet lag (especially West to East)
  • Severe life stress
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16
Q

What is hypomania?

A
  • State of increased energy without psychotic symptoms or need for hospitalizatoin
  • Less intense form of mania
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17
Q

What type of bipolar diagnosis is made in patients with hypomania?

A

Bipolar II

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18
Q

What symptoms result in classification of mania, not hypomania?

A
  • Paranoia
  • Delusions
  • Hallucinations
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19
Q

Patients are often (aware/unaware) of their mania?

A

Unaware (feel too good to be an illness)

Family, friends, or the legal system bring it to their attention

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20
Q

What is characteristic of Bipolar Course I?

A

Rapid cycling (4 or more mood episodes per year)

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21
Q

What is characteristic of Bipolar Course II?

A
  • Mainia/depression may last for 4-8 months and remit spontaneoulsy
    • May go years without episodes
    • Depression may be chronic (last years)
22
Q

What is characteristic of Bipolar Depression 1?

A
  • “Atypical depression”
  • Excessive sleeping
  • Increased eating
  • Suicide risk
  • Teen atypical depression may be first sign of bipolar disorder
23
Q

What is characteristic of Bipolar Depression 2?

A
  • Often “atypical” features (increased sleeping, eating)
  • May be seasonal (winter depressions, etc.)
  • May have psychosis (hearing voices, delusions)
24
Q

What is characteristic of Bipolar Depression 3?

A
  • Suicide happens in this phase
  • Hypothyroidism (may result from Lithium use)
    • Symptoms similar to depression
  • Alcohol use may start during this phase
25
What are the side effects of using Lithium to treat bipolar disorder?
**LMNOP** **L**ithium side effects: * **M**ovement (tremor) * **N**ephogenic diabetes insipidus * Hyp**O**thyroidism * **P**regnancy problems
26
What is characteristic of Bipolar Depression 4?
* Most patients have **more depression than mania** * Depression **more debilitating** * Treatment more difficult for depression * Antidepressant use can push depression into mania
27
What is Cyclothymic Disorder?
* Presence of **hypomanic symptoms ** for **at least 2 years** that **don't meet criteria** for full hypomanic episode and numerous periosds of **depressive symptoms** that **don't meet criteria** for full major depressive episode * Results in distress or functional impairment * Chronic, smoldering form of bipolar illness (not as severe as bipolar but can progress to it)
28
What is the treatment plan for patients with addiction and bipolar disorder?
* Must **treat addiction** and **mood disorder** * Often harder to treat than those with only bipolar
29
What is the Mania Criterion A in DSM5?
A **distinct period of abnormally** and **persistently elevated, expansive,** or i**rritable mood** AND **abnormally** and **persistent increased goal directed activity** or **energy** - lasting **1 week** and present most of the day, nearly every day (or any duration if hospitalization is necessary)
30
What is the Mania Criterion B in DSM5?
* Inflated self esteem or grandiosity * Decreased need for sleep * Distractability * More talkative than usual, with pressured/rapid speech * Flight of ideas or racing thought * Increased goal directed behavior or agitation * Excessive involvement in pleasurable activities (sex, cars, money) that may have painful results
31
What is a good mnemonic for mania diagnosis during a mental status exam?
**DIGFAST** (must have at least 3 of 7 symptoms) * **D**istractible * **I**ncreased activity/psychomotor agitation * **G**randiosity/Superhero mentality * **F**light of ideas or racing thought * **A**ctivities that are dangerous or hypersexual * **S**leep decreased * **T**alkative or pressured speech
32
What are some soft signs of mania?
* Large hats on men * Multiple rings on men * Excessive visible cleavage on women or exposed chest on men * Public nudity * Public masturbation
33
Compare the Bipolar disorder types and cyclothymic disorder.
* **Bipolar I** - Manic episode (see **psychosis** or need **hospitilization**), with or **without episode of major depression** * **Bipolar II** - **Major depressive episodes** & **hypomanic** episodes * Cyclothymic Disorder - **Hypomanic** and **depressive** episodes for at least **2 years** that **don't meet criteria** of full hypomanic or depressive episodes
34
What is the difference between mania and schizophrenia?
* Mania thoughts are often disorganized, abundant, elaborate, and sometimes playful * Schizophrenia thoughts are more bland, fragmented, bizarre with affect less intense
35
What is kindling?
* Like a seizure disorder (once you have one, the easier is is to have another) * Low levels of electrical impulses that start with no effect, then seizures in response to the same impulse * Eventually spontaneous seizures follow without impulse * **Bipola**r first related to **environmental** changes, **loss**, **stress**, **drugs**, **sleep deprivation** * Ultimately **autonomous cycling**
36
What are **classic mood stabilizers** for bipolar disorders?
* Lithium * Valproic acid * Carbamazepine
37
What are some **new options** for pharmacological management of bipolar disorders?
* Aripiprazole, Quetiapine, Risperidone, Ziprasidone, Olanzapine * Chlorpromazine (FGA)
38
What is the pharmacological option for treating **bipolar-depression**?
**Fluoxetine-Olanzapine** combination
39
What medication is used for **maintenence** of bipolar disorder and what is a potential risk of using it?
* **Lamotrigine** * Steven-Johnson syndrome
40
What are the therapeutic levels of **Lithium**?
**0.8 - 1.2 mEq/L** (over this amount can be toxic)
41
What is sometimes required at **toxic** levels of Lithium?
Hemodialysis
42
What are some adverse effects of Lithium?
* Tremor * Sedation * Ataxia * Aphasia * **Thyroid enlargement** * Edema * Acneiform skin eruptions * **Teratogenic: Ebstein anomaly**
43
What are the therapeutic levels of **Valproate**?
**50 - 100 μg/mL** (over this amount can be toxic)
44
What is the mechanism of action for Lithium?
* Inosital depletion * Glycogen synthase kinase (GSK-3) inhibition * Glutamate stabilization
45
What is the mechanism of action for Valproate?
* Reduction of plasma GABA (GABAeric; increases GABA at cleft) * Protein kinase C reduction * Glycogen synthase kinase (GSK-3) inhibition
46
What are some adverse effects of Valproate?
* GI (nausea, vomiting, diarrhea, anorexia) * Tremor * Sedation * Hair loss * **Pancreatitis (Can kill patient; Black Box Warning)** * Hepatotoxicity * Weight gain * **Birth defects (Neural tube defects)**
47
What is the mechanism of action of **Carbamazpine** & **Oxcarbamazepine**?
Voltage gated Na+ and Ca2+ channel blocker
48
What are some adverse effects of **Carbamazpine & Oxcarbamazepine?**
* Sedation, dizziness * Nausea, vomiting * Benign leukopenia * Rash * **Rare Aplastic Anemia, agranulocytosis** (do blood work) * **Steven Johnson Syndrome (Life threatening; very serious)** * **SIADH** (syndrome of inappropriate ADH) **with hypnaturemia**
49
What is the therapeutic levels of **Carbamazepine** & **Oxcarbamazepine**?
**4 - 12 μg/mL**
50
What is the therapeutic levels of **Lamotrigine**?
None recommended
51
What is the mechanism of action of **Lamotrigine**?
Voltage gated Na+ and Ca2+ channel blocker
52
What are some adverse effects of **Lamotrigine**?
* Sedation, dizziness * Nausea, vomiting * Benign rash * **Stevens Johnson Syndrome (Life threatening; very serious)**

BB Test 3 (26 decks)

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