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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
Q

What are the side effects of using Lithium to treat bipolar disorder?

A

LMNOP

Lithium side effects:

  • Movement (tremor)
  • Nephogenic diabetes insipidus
  • HypOthyroidism
  • Pregnancy problems
26
Q

What is characteristic of Bipolar Depression 4?

A
  • Most patients have more depression than mania
  • Depression more debilitating
  • Treatment more difficult for depression
    • Antidepressant use can push depression into mania
27
Q

What is Cyclothymic Disorder?

A
  • 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
Q

What is the treatment plan for patients with addiction and bipolar disorder?

A
  • Must treat addiction and mood disorder
    • Often harder to treat than those with only bipolar
29
Q

What is the Mania Criterion A in DSM5?

A

A distinct period of abnormally and persistently elevated, expansive, or irritable 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
Q

What is the Mania Criterion B in DSM5?

A
  • 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
Q

What is a good mnemonic for mania diagnosis during a mental status exam?

A

DIGFAST (must have at least 3 of 7 symptoms)

  • Distractible
  • Increased activity/psychomotor agitation
  • Grandiosity/Superhero mentality
  • Flight of ideas or racing thought
  • Activities that are dangerous or hypersexual
  • Sleep decreased
  • Talkative or pressured speech
32
Q

What are some soft signs of mania?

A
  • Large hats on men
  • Multiple rings on men
  • Excessive visible cleavage on women or exposed chest on men
  • Public nudity
  • Public masturbation
33
Q

Compare the Bipolar disorder types and cyclothymic disorder.

A
  • 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
Q

What is the difference between mania and schizophrenia?

A
  • Mania thoughts are often disorganized, abundant, elaborate, and sometimes playful
  • Schizophrenia thoughts are more bland, fragmented, bizarre with affect less intense
35
Q

What is kindling?

A
  • 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
  • Bipolar first related to environmental changes, loss, stress, drugs, sleep deprivation
    • Ultimately autonomous cycling
36
Q

What are classic mood stabilizers for bipolar disorders?

A
  • Lithium
  • Valproic acid
  • Carbamazepine
37
Q

What are some new options for pharmacological management of bipolar disorders?

A
  • Aripiprazole, Quetiapine, Risperidone, Ziprasidone, Olanzapine
  • Chlorpromazine (FGA)
38
Q

What is the pharmacological option for treating bipolar-depression?

A

Fluoxetine-Olanzapine combination

39
Q

What medication is used for maintenence of bipolar disorder and what is a potential risk of using it?

A
  • Lamotrigine
    • Steven-Johnson syndrome
40
Q

What are the therapeutic levels of Lithium?

A

0.8 - 1.2 mEq/L (over this amount can be toxic)

41
Q

What is sometimes required at toxic levels of Lithium?

A

Hemodialysis

42
Q

What are some adverse effects of Lithium?

A
  • Tremor
  • Sedation
  • Ataxia
  • Aphasia
  • Thyroid enlargement
  • Edema
  • Acneiform skin eruptions
  • Teratogenic: Ebstein anomaly
43
Q

What are the therapeutic levels of Valproate?

A

50 - 100 μg/mL (over this amount can be toxic)

44
Q

What is the mechanism of action for Lithium?

A
  • Inosital depletion
  • Glycogen synthase kinase (GSK-3) inhibition
  • Glutamate stabilization
45
Q

What is the mechanism of action for Valproate?

A
  • Reduction of plasma GABA (GABAeric; increases GABA at cleft)
  • Protein kinase C reduction
  • Glycogen synthase kinase (GSK-3) inhibition
46
Q

What are some adverse effects of Valproate?

A
  • 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
Q

What is the mechanism of action of Carbamazpine & Oxcarbamazepine?

A

Voltage gated Na+ and Ca2+ channel blocker

48
Q

What are some adverse effects of Carbamazpine & Oxcarbamazepine?

A
  • 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
Q

What is the therapeutic levels of Carbamazepine & Oxcarbamazepine?

A

4 - 12 μg/mL

50
Q

What is the therapeutic levels of Lamotrigine?

A

None recommended

51
Q

What is the mechanism of action of Lamotrigine?

A

Voltage gated Na+ and Ca2+ channel blocker

52
Q

What are some adverse effects of Lamotrigine?

A
  • Sedation, dizziness
  • Nausea, vomiting
  • Benign rash
  • Stevens Johnson Syndrome (Life threatening; very serious)

BB Test 3 (26 decks)

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