Bipolar Disorder Flashcards
Manic Episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and persistently increased goal directed activity or energy, lasting at least one week. Three or more of (for or more if mood is irritable) and represents a change from unusual behavior:
2 exceptions for one week time frame:
Psychotic as a result of manic sx
Hospitalized for mania
Manic Episode Symptoms
Inflated self esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Distractibility
Increase in goal oriented activity
Excess involvement in activities that have a high potential for painful consequences (ex overspending, inappropriate sexual advances, infidelity, hypersexuality, legal problems)
Hypomanic Episode
Can be part of bipolar I and II
Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 4 days and three or more or manic symptoms required (for if mood is irritable)
Unequivocal change in functioning
Observable by others
Not severe enough to cause marked impairment
No psychosis or hospitalization
Bipolar I
Manic episodes (usually includes both manic and depressed)
Bipolar II
Depressed episodes + hypomanic episodes
Cyclothymia
Patients do not get manic get hypomanic
Do not get depressed get dysthymic
35 year old F reporting sx of a depressed episode. You ask how she was doing before. She reports feeling quite good for 5 days. She did not require as much sleep and was feeling very goal directed. She went though boxes from a recent move. Prior to depressed episode she likely experienced?
Hypomanic episode
Disruptive mood Dysregulation Disorder
New diagnosis. Children with frequent temper tantrums. Bipolar like thing in children. Kids with cycling mood. Irritability, temper tantrums.
Cyclothymic disorder
Dysthymia +hypomania periods
Premenstrual dysphoric disorder
In the majority of menstrual cycles at least 5 sx starting the week before menses and ending after.
A 68 year old woman with hx depression brought in by police after she was found destroying her home with a sledgehammer and concerned neighbors called the police. She snaps at you and states “my smoke detectors would not stop beeping, what was I supposed to do?” For the last week, she has only been sleeping 2 hours at night, is distractible, talkative, and reports racing thoughts.
Manic episode.
Not hypomanic bc she is having dysfunction by ruining her house.
Course of Bipolar Disorder
Onset 19-29 years Episodes Manic episodes last 5-10 weeks Depressed episodes last 19 weeks Average number of episodes in a lifetime is 10 Lifetime prevalence 1-3%
Genetics
ID twins show 50-75% concordance for bipolar disorder
Treatment Planning
Practical and emotional support
Social considerations
Available caregivers, health facilities
For ambulatory/outpt treatment, combinations of medication and psychotherapy, and sleep hygiene is crucial
Hospitalize for psychosis, suicidality, continued self harm due to substances, inability to care for self, medical problems, legal problems
Treating Bipolar Disorder
Mood Stabilizers (some are anticonvulsants)
Lithium- gold standard. Works for depression, mania, and maintenance
Carbamazepine and valproate (works for mania and maintenance)
Lamotrigine (for bipolar depression and maintenance)
Atypical antipsychotics for mania/ mixed/ bipolar depression +/- psychosis
Stop antidepressants
Sleep hygiene/ benzos
Psychotherapy
ECT
