Bipolar Disorder

Question 1

Avg age of onset for bipolar

Answer 1

25 y/o. Men have earlier onset than women.

Question 2

Gender ratio for bipolar

Answer 2

Women more common 3:2

Question 3

Common co-morbidities w/ bipolar

Answer 3

substance abuse (60%) and anxiety (50%)

Question 4

What percentage of pxs w/ bipolar I complete suicide?

Answer 4

10-15%

Question 5

Neuroimaging findings for bipolar (5 things)

Answer 5

Enlarged ventricles, increased deep white matter lesions (mainly in frontal lobe), decreased gray matter in limbic system, increased metabolism in anterior cingulate cortex, and decreased metabolism in PFC.

Question 6

Chemical / neuronal findings in bipolar.

Answer 6

Low neuropil volume and low levels of N-acetylaspartate (NAA) in PFC, anterior cingulate cortex, and hippocampus. Lithium increases NAA by blocking inositol triphosphate, which inhibits formation of new synapses.
High cortisol.
High inflammatory cytokines.

Question 7

How long must a manic / hypomanic episode last, by definition?

Answer 7

1 week for manic

4 days for hypomanic

Question 8

Bipolar disorder due to another medical condition (5 categories)

Answer 8

Endocrine disorders (hyperthyroidism), neurological disorders (MS, frontotemporal dementia, Huntington’s disease, epilepsy), neoplasia (especially tumors in the frontal lobes), cerebrovascular disease (especially strokes in the right frontal lobe), and infection (HIV/AIDS, neurosyphilis, and herpes encephalitis).

Question 9

Substance / Medication induced bipolar

Answer 9

Psychostimulants (cocaine / amphetamines), antidepressants, glucocorticoids, and antibiotics

Question 10

Treating manic episodes

Answer 10

• Lithium is gold standard
• Valproic acid (anticonvulsant) may be more effective than lithium for mixed features.
• Atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole) used for psychotic sxs.
• Benzos may help w/ anxiety, agitation, and insomnia. Adjunctive. Provides more immediate relief b/c lithium / anticonvulsants take days to work.
• Psychotherapy is NOT effective.

Question 11

What are 2 side effects of lithium?

Answer 11

• Lithium reduces ability to concentrate urine. Pee a lot and drink a lot.
• Epstein’s anomaly is a teratogenic effect from lithium.

Question 12

Treating depressive episodes

Answer 12

• Do NOT use antidepressants w/o mood stabilizer such as lithium, anticonvulsant, or antipsychotic.
• Lithium, atypical antipsychotics, and lamotrigine (anticonvulsant) have antidepressant properties.
• Psychotherapy may be effective
• ECT results in rapid resolution of severe or refractory episodes of depression or mania.

Question 13

Maintenance treatment

Answer 13

• Kindling – episodes become more frequent, severe, and refractory to treatment over time. Maintenance is very important to avoid this.
• Lithium (best at preventing mania) and lamotrigine (anticonvulsant; best at preventing depression) are best for maintenance. Others include valproic acid and atypical antipsychotics.

Question 14

Interpersonal / social rhythm therapy

Answer 14

Pxs keep track of time of day they wake up, eat meals, have 1st contact w/ another person, and go to sleep. Try to keep these consistent.