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Bipolar disorder Flashcards

1
Q

Bipolar I Disorder

A
  • manic episode required (1 or more per lifetime)
  • will likely have more than 1 manic episode during lifetime
  • commonly have
    other types of episodes (depressive, hypomania, etc.) thru life that sometimes precede or proceed manic episodes.
  • no other types of episodes required to make dx except MANIA!
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2
Q

manic episode/mania

A
  • a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1-WEEK or less IF a patient must be hospitalized.
  • during this same period, 3/7 DIGFAST symptoms persist and cause impairment in social and/or occupational functions.
  • not otherwise explained by physiological effects of a substance.
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3
Q

DIGFAST

A

DISTRACTABILITY

INSOMNIA (Either no sleep at all or very minimal sleep)

GRANDOSITY (an unrealistic sense of superiority, inflated self-esteem)

FLIGHT OF IDEAS (observable OR patient’s subjective feeling of having racing thoughts)

ACTIVITIES/AGITATION (increase in goal-directed activity or psychomotor agitation

SPEECH (more talkative than usual or pressure to keep talking)

THOUGHTLESSNESS (engaging in potentially harmful activities, transactions

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4
Q

Mood

A

A pervasive, sustained emotion or feeling tone that influences a person’s behavior and influences their perception of the world.

  • Sometimes observed (sadness).
  • Sometimes can only be felt by the patient (i.e. hopelessness).
  • Examples: depressed, sad, empty, melancholic, distressed, irritable, elated, euphoric, manic, gleeful, etc.
  • Dynamic, to a degree.
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5
Q

If mood is only irritable and not euphoric, _/7 DIGFAST symptoms are required for diagnosis of bipolar disorder I.

A

If mood is only irritable and not euphoric, 4/7 DIGFAST symptoms are required for diagnosis of bipolar disorder I.

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6
Q

If there is psychosis or hospitalization with other sx, it is considered _____.

A

If there is psychosis or hospitalization with other sx, it is considered MANIA.

(vs. hypomania).

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7
Q

Bipolar II Disorder

A

at least 1 of each throughout lifetime:

  • hypomanic episode
  • major depressive episode
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8
Q

Hypomanic episode

A

A distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 4 DAYS.

  • during same period, 3/7 DIGFAST sx persist,
    OR 4/7, as with mania, if mood is only irritable and not euphoric.
  • change in functioning, but NO marked social and/or occupational impairment (no hospitalization).
  • not otherwise explained by physiological effects of a substance.
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9
Q

Major Depressive Episode

A

At least 5/9 following sx, during at least a 2-week period, with at least 1/5 sx being depressed mood or loss of pleasure:

  • Depressed mood
  • Decreased interest and/or pleasure in most activities
  • Decrease in appetite
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue, loss of energy
  • Feelings of worthlessness and/or excessive guilt
  • Difficulty in thinking, concentrating, or indecisiveness
  • Recurrent thoughts of death
  • Significant distress or impairment in functioning.
  • Episode NOT attributable to substances and/or a medical condition.
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10
Q

Cyclothymic Disorder

A

Less severe, milder Bipolar II Disorder.

  • alternating hypomania and depression, without ever fully meeting criteria for either episode.
  • lasts at least 2 yr in adults.
  • lasts at least 1 yr in children and adolescents.
  • CHANGES in mood are ABRUPT, occur within hours.
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11
Q

Lifetime Prevalence Rates (%)

A

Bipolar 1 Disorder
0-2.4 %

Bipolar II Disorder
0.3-4.8 %

Cyclothymia
0.5-6.3 %

Hypomania
2.6-7.8 %

Major Depressive Disorder
5-17 %

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12
Q

Clinical Features Predictive of Bipolar Disorder (vs. MDD)

A
  • Early age at onset
  • Psychotic depression before 25 y/o
  • Postpartum depression, especially if psychotic too
  • Recurrent depression (5+ episodes)
  • Depression with psychomotor retardation
  • Atypical features (reverse vegetative signs)
  • Seasonality
  • FHx Bipolar Illness

High-density, three-generation pedigrees

  • Trait mood lability (cyclothymia)
  • Hypomania associated w/ antidepressants
  • Repeated (at least 3x) loss of efficacy of antidepressants after initial response
  • Depressive mixed states
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13
Q

Major Depression Disorder

sex
mean age onset
age range of onset
marital status
socioeconomic and culture
A

2x greater in women than men

30 y/o

20-50 y/o (inc in youth)

more comm in divorced/separated

no correlation to socioeconomic/culture

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14
Q

Bipolar I Disorder

sex
mean age onset
age range of onset
marital status
socioeconomic and culture
A

M=W

40 y/o

5/6-50 y/o

more common in divorced and single

inc incidence in upper socioeconomic groups

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15
Q

Major Depression Disorder: lifetime prevalence of comorbidities

A

substance use disorder: 27%

panic disorder: 10%

obsession-compulsive disorder: (12%)

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16
Q

Bipolar Disorders: lifetime prevalence of comorbidities

A

SUBSTANCE USE DISORDER: 61%

panic disorder: 21%

obsession-compulsive disorder (21%)

17
Q

differential diagnoses for depressive sx

A 
Adjustment disorder with depressed mood
ETOH-use d/o
anxiety disorders
eating d/o
bipolar I, II, 
cyclothymia
dysthymia
MDD
minor depressive d/o
mood d/o 2/2 general medical condition
recurrent brief depressive d/o substance-induced mood d/o schizophrenia
schizophreniform d/o
somatoform d/o
18
Q

differential diagnoses for manic sx

A 
Bipolar I d/o
bipolar II d/o
cyclothymic d/o
mood d/o 2/2 general medical condition
substance-induced mood d/o personality d/o
19
Q

Compared to MDD, bipolar I disorder prognosis is worse or better?

20
Q

Lithium prophylaxis tx for bipolar I

A

50-60% achieve control w/ Li

21
Q

fx of poor prognosis for bipolar I disorder

A
  • Premorbid occupational status
  • Alcohol dependence
  • Psychotic and/or depressive features
  • Male
22
Q

fx of better prognosis for bipolar disorder

A
  • SHORT duration of mania
  • OLDER age of onset
  • few suicidal thoughts
  • few psychiatric or medical comorbidities
23
Q

antidepressant tx for bipolar disorder

A

Ineffective, risk of mania, rapid-cycling

24
Q

mood stablizer tx for bipolar disorder

A

Most effective for maintenance treatment.

In mania, most often need combination with antipsychotic or benzodiazepine (short-term

25
Q

antipsychotic tx for bipolar disorder

A

Effective for both mania and depressive episodes

26
Q

antidepressant tx for MDD

A

1st line

most effective when combined w/ therapy

27
Q

mood stablizer tx for MDD

A

Sometimes used as augmentation w/ antidepressant in SSRI non- and/or partial responders.

NOT 1st-line

28
Q

antipsychotic tx for MDD

A

Sometimes used as augmentation w/ antidepressant in SSRI non- and/or partial responders.

not 1st-line

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