Bipolar Disorder Flashcards
Bipolar I or Biplolar II:
Delusions
Bipolar I
Bipolar I or Biplolar II:
Symptoms may be present for 4-6 days
Bipolar II
Bipolar I or Biplolar II:
May present with mixed features
Both
Bipolar I or Biplolar II:
Depressive Episode NOT a diagnostic requirement
Bipolar I
Bipolar I or Biplolar II:
Patients are typically in depressed state 15x more than hypomanic state
Bipolar II
Bipolar I: depressed 2x more than manic)
Bipolar I or Biplolar II:
Can be mistaken for cyclothymia
Bipolar II
Bipolar I or Biplolar II:
More likely to have hypomanic episode
Bipolar I
Bipolar I or Biplolar II:
Cause signfiicant impairment in social or occupational function, necessitating psychiatric hospitalization
Bipolar I
Bipolar I or Biplolar II:
Equal likelihood between males and females
Bipolar I
Gender more likely to have 1st mood disturbance be a manic episode
Males
% risk of future mood episode if 1st mood disturbance is manic episode
85%
What is the risk of bipolar disorder if your identical twin has it?
70%
Average age of onset for Bipolar I and Bipolar II
Bipolar I: 18
Bipolar II: Mid-20s
What happens to length of manic episode with each ensuing episode
Lengthens/Increases
Which side of family, if affected, carries lower risk of bipolar disorder
Paternal Side (Father)
After 1st mood disturbance in Major Depression, risk of future depression episode is:
50%
After 2 episodes: 70%
After 3 episodes : 90%
For patients with bipolar disorder, as the total number of mood episodes increases, the interepisode
interval does this
Shortens/Decreases
Average lifetime # of manic episodes a patient will have is? Unless what is done?
9-10 episodes
Need maintenance medication treatment
Which medication is avoided in treating bipolar patients with liver disease?
Depakote
Which medication can be rapidly loaded in bipolar patients, showing improvmeent in first 3 days
Depakote
What is the Rule of 1/3 in Bipolar Disorder
Lithium or Depakote Monotherapy successfully treat manic episodes to resolution in 1/3 of patients
Rule: 1/3 respond well, 1/3 partial response, 1/3 respond poorly
Lithium’s response rate in treating bipolar patients with euphoric mood, family history of the illness, and/or few lifetime episodes is this
70% (GOOD)
Lithium Lithium + FGA/SGA Divalproex (Depakote) Divalproex (Depakote) + FGA/SGA ------------------------------- The first choice for treating a severe acute manic episode is this
Lithium + FGA/SGA or divalproex (depakote) + FGA/SGA
When is maintenance treatment always recommended?
After 2 manic episodes
Usually given after 1 episode as well
Which bipolar disorder medicaiton decreases risk of suicide?
Lithium
Which medication is avoided in treating bipolar patients with renal disease?
Lithium
Which medication is avoided in treating bipolar patients who are obse?
Olanzapine (Zyprexa)
What can happen if Lithium is discontinued abruptly over days? How is this avoided
Affective Switch to Mania
Lower risk by discontinuing gradually over months
What medication combination is effective in treating bipolar depression with no increased risk of switch to manic episode?
Symbyax: Olzanzapine +Fluoxetine
Which antidepressants lead to increased switch rate and increased number of rapid cycling cases?
TCA and SNRIs
What is contraindicated in treatment of bipolar I Depression
Antidepressant Monotherapy
Which antidepressant has least risk of inducing a manic episode
Buproprion (Wellbutrin)
What medications are recommended for treating bipolar depression
Lithium Quetiapine (Seroquel) Lurasidone (Latuda) Lamotrigine (Lamictal) Olanzapine/Fluoxetine (Symbyax)
While often used as an adjunct treatment of major depression, this SGA is NOT shown to be beneficial in the treatment of bipolar depression
Aripiprazole (Abilify)
When using an antidepressant to treat bipolar depression, this should be done after the episode has remitted
Discontinue the antidepressant
What can Lamotrigine be used for?
Treat acute bipolar depression
Maintenance treatment
What should Lamotrigine NOT be used for?
NOT for acute manic episode
Which bipolar medication has the narrowest gap between therapeutic and toxic concentration in psychiatry
Lithium
To rapidly load a patient weighing
150 pounds with 20 mg/kg of divalproex (depakote), this amount of the medication is prescribed
1500mg
% of bipolar patients who dies by suicide
16% (20x risk of general population)
How is severe lithium toxicity treated
Dialysis
What symptom is indicative of onset of new manic episode
decreased need for sleep
Mania then depression or
Depression then mania
This happens 60% of the time
Mania then Depression
Individuals in a manic episode frequently resist efforts to treat them because they do not recognize that they are ill which is called this
Anosognosia (lack of insight)
