Bipolar Disorder Flashcards
What is the definition of bipolar disorder?
Spectrum of cyclic mood disorder (think rollercoaster)
How do bipolar patients go through sx?
Cycle between depression and mania/hypomania
What is the first BD episode in males most likely to be?
Manic episode
What is the first BD episode in females more likely to be?
Major Depressive Episode
How often are BD patients symptomatic?
Frequently (almost 50% of the time
If a patient with BD has co-morbidities, how does that affect treatment?
Requires lots of care and intervention
What hypothesis does BD treatment target?
Neurotransmitter hypothesis
What are the RFs for BD?
Genetic component = FH (BD, MDD, Suicide)
Stressors (divorce, legal problems, financial problems, substance abuse/use, job loss)
Medications (antidepressants, decongestants, stimulants, EtOH, cocaine, amphetamines, caffeine, corticosteroids)
What is the essential feature of BD?
Characterized by the occurrence of manic episodes, hypomanic episodes, or mixed episodes
Often individuals have also had major depressive episodes
What is the average age of BD onset?
20 yo
What is the average amount of episodes in a 10 year period?
4 episodes
What implications does BD have?
Neuropsychologic implications
What is rapid cycling?
4 or more mood episodes in a 12 month period
Who should be screened for BD?
18-40 yos with RFs
Patients that may describe not feeling like themselves at times
What are the tools for psychometric screening?
MDQ
What is the criteria for Manic Episodes?
At least 1 week (or any duration of hospitalization)
3 or more GIDDINES sx
Severe enough to cause marked impairment
What does GIDDINES stand for?
Grandiose; increased self-esteem Increased activity (goal directed/highly risk) Decreased judgement Distractibility; flight of ideas Irritability Need less sleep Elevated mood Speedy talking
What is the criteria for hypomanic episodes?
At least 4 consecutive days
3 or more GIDDINES sx
Not severe enough to cause marked impairment
What is Bipolar Type I?
Mania Psychosis often present Impaired functioning Hospitalization often required Duration = months
What is Bipolar Type II?
Hypomania No psychosis Functioning slightly impaired to improved Hospitalization not required Duration = weeks
What is Cyclothemia?
At least 2 years with periods of hypomanic and depressive symptoms
Does not occur for more than 2 months at a time but is present > 1/2 the time
What is mixed BD?
Patient with sx of both mania and depression simultaneously
If a patient has severe sx, how does that affect diagnosis?
Typically requires hospitalization and makes diagnosis more difficult
Does not fall under DSM-5 criteria
How long do medications take for onset of action or sx improvement?
7-10 days
How long do medications take to improve mood symptoms?
4-6 weeks
What is DOT for BD?
Typically life long, once diagnosis is made
What are 1st line therapies for BD?
Lithium VPA AAP/SGA Consider 2 drug combo (MS + AAP) CBZ 1st or 2nd line depending on guideline (has FDA indication)
What are the 2nd line therapies for BD?
Try a different first line therapy (little to no response)
Consider 2 drug combo (if partial response)
CBZ or OxCBZ (generally not used)
What do we use to monitor response/effectiveness of drug therapy in Bipolar/mania?
YMRS
What are the first line therapies for acute bipolar depression?
Lithium Lamotrigine Quetiapine VPA or olanzapine/fluoxetine combo
What are the second line monotherapies for bipolar depression?
Try a different first line therapy
Lurasidone (FDA indication)
