Bipolar Disorder Flashcards
Patients may experience ________ in bipolar I disorder.
delusions
How long do symptoms last in bipolar II disorder?
4 - 6 days
Mixed features may be present in which type of bipolar disorder?
Bipolar I or Bipolar II disorder
A depressive episode is NOT a diagnostic requirement for which type of bipolar disorder?
Bipolar I disorder
Patients are typically in depressed state 15 x’s more than a (hypo)manic state
in which type of Bipolar disorder?
Bipolar II disorder
Patients are typically in depressed state 2x’s more than a (hypo)manic state
in which type of Bipolar disorder?
Bipolar I disorder
Which type of bipolar disorder is easily mistaken for cyclothymia?
Bipolar II Disorder
Patients are more likely to have a hypomanic episode with this type of Bipolar disorder.
Bipolar I disorder
Which type of bipolar disorder causes significant impairment in social or occupational function or necessitates psychiatric hospitalization?
Bipolar I disorder
The likelihood of a male or
female having this illness
is essentially equal.
Bipolar I disorder
Which sex is more likely to have a first mood disturbance be a manic episode?
Males
If the 1st mood disturbance is
a manic episode the risk of
future mood episodes is
this percentage.
85% (80 - 90%)
If this relative is diagnosed with Bipolar Disorder, your
risk is ~70%
Your identical twin
The average age of onset for Bipolar II is what age?
mid-20’s
The average age of onset for Bipolar I is what age?
18 years old
With each ensuing episode, the length of time a patient spends in a manic episode does this
lengthens/increases
For someone with a family history of bipolar disorder, the risk is lower if the affected relative is on this side of the family.
Paternal side (father)
After the 1st, 2nd, or 3rd mood disturbance in Major Depression, the risk of future depression episodes
is what percentages?
After 1 episode: risk is 50%
After 2 episodes, risk is ~70%
After 3 episodes, risk is ~90% (definitely do maintenance treatment)
For patients with bipolar disorder, as the total number of mood episodes increases, the interepisode interval does this
shortens/decreases
The average lifetime number of manic episodes a patient will have is 9-10 unless the physician does this
give maintenance medication treatment
What medication is generally avoided in the treatment of
Bipolar patients with liver disease?
divalproex (depakote)
This medication can be rapidly loaded and patients who respond improve the most in the first 3 days
divalproex (depakote)
Lithium or Divalproex (depakote) monotherapy successfully treat manic episodes to resolution in
1 out of this many patients
Rule of 1/3’s:
1/3 respond well
1/3 partial respond
1/3 respond poorly
What is Lithium’s response rate in treating bipolar patients with euphoric mood, family history of the illness, and/or few lifetime episodes?
70% (good/very good)
What medication is the first choice for treating a severe acute manic episode?
Lithium + FGA/SGA or Divalproex (depakote) + FGA/SGA
Maintenance treatment should always be recommended after how many manic episodes?
2 (most of the time after 1 episode)
For patients with bipolar disorder, treatment with which medication appears to decrease the risk of suicide?
Lithium
Which medication is generally avoided in treating bipolar patients with renal disease?
Lithium
Which medication is generally avoided in treating bipolar patients who are obese?
Olanzapine (Zyprexa)
The risk of this adverse outcome is lower if lithium is discontinued gradually over months rather abruptly over days.
risk of an affective switch to mania
This combination medication contains fluoxetine (prozac) and is effective in treating bipolar depression with no increased risk of a switch to a manic episode.
Olanzapine/Fluoxetine (symbyax)
Since these types of antidepressants were introduced, studies have shown an increased switch rate & an
increase in the number
of rapid cycling cases
tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRI’s)
Use of this treatment regimen for patients with bipolar I depression is contraindicated
antidepressant monotherapy
Of all the antidepressants, using this one appears to carry the least risk of inducing a manic episode.
bupropion (wellbutrin)
Name the 5 medications that 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
This medication can be used to treat acute bipolar depression and for maintenance treatment, but NOT for an acute manic episode
lamotrigine (lamictal)
Used in the treatment of bipolar disorder, this medication has the narrowest gap between therapeutic & toxic concentration of any drug routinely prescribed 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
1500 mg
What is the percentage of patients with bipolar disorder whose life ends by suicide?
16% (20x’s the relative risk of the general population and about the same as major depression)
How is life-threatening lithium toxicity treated?
Dialysis
Often this symptom heralds
the onset of a new manic episode
decreased need for sleep
Which happens 60% of the time?
Mania then depression or
Depression then mania
Mania then depression
Which happens 40% of the time?
Mania then depression or
Depression then mania
Depression then mania
Individuals in a manic episode frequently resist treatment efforts because they do not recognize that they are ill, which is called _______.
anosognosia (lack of insight)
What laboratory finding is diagnostic of a manic episode?
There is no diagnostic finding associated with mania
