Bipolar Disorder

Question 1

Manic Episode criteria: Need how many?

Answer 1

3 or more, 4 if irritability is the only feature. 1 week OR hospitalization

Question 2

Hypomanic episode criteria: Need how many and for how many days?

Answer 2

3 or more. 4 if irritability is the only feature. 4 consecutive days. Needs to be observable by others.

Question 3

Catatonia as a specifier

Answer 3

Need 3 of: posturing, gmannerism, sterotypy, agitation not influenced by external stimuli. grimacing, echolalia, echopraxia.

Question 4

Cyclothymic Disorder

Answer 4

2 years. Symptoms present at least half the time and patient has not been without symptoms for more than 2 months at a time.

Question 5

Primary Mania vs Secondary Mania

Answer 5

Primary mania is early onset, no obvious medical cause, high family history of bipolar disorder, and good response to lithium. Mania secondary to meds will have a poor response to lithium.

Question 6

Rapid cycling, what counts?

Answer 6

All mood including manic, hypomanic, AND depressed

Question 7

How does lithium ultimately work?

Answer 7

Has effects on second messengers and gene expression. Slows down signal transduction in neurons.

Inhibits inositol monophosphatase.

Question 8

Meds with bipolar depression indications

Answer 8

Symbyax, quetiapine, latuda. NO lamictal.

Question 9

Latuda is only SGA that is not approved for

Answer 9

mania

Question 10

Which antidepressant is least likely to switch?

Answer 10

wellbutrin

Question 11

Lithium is least helpful in

Answer 11

mixed states. Instead use valproic acid, tegretol, geodon, abilify, or asenapine.

Question 12

Lithium and end of pregnancy

Answer 12

Prior to delivery, decrease dose to half or stop temporarily. Neonatal toxicity is floppy baby syndrome (cyanosis, hypotonicity ) from exposure during labor. `

Question 13

Valproate dosing

Answer 13

20 mg/kg to load, then start at 750. Target blood level is 90.

Question 14

Symptoms of hepatotoxicity from depakote

Answer 14

Malaise, weakness, lethargy, facial edema, anorexia, vomiting. The LFTs aren’t super helpful . May see hyperammonemia.

Question 15

Depakote causing pancreatic adverse effects

Answer 15

VPA-caused pancreatitis may occur. Can get hemorrhagic, quickly leading to death.

Question 16

Depakote and PCOS

Answer 16

4-10% of pts on VPA get it within 1 year

Question 17

Depakote and OCP

Answer 17

Depakote interacts with OCP to lower the level, making pregnancy more likely.

Question 18

Tegretol and Asian Patients

Answer 18

You MUST get genetic testing for HLA B1502, as that is associated with SJS

Question 19

Lamictal risk of SJS

Answer 19

1/1000 with rapid titration, 1/6000 with slow titration. Target dose is 200-400 mg. Risk increases beyond that.

Question 20

What type of therapy is good for bipolar?

Answer 20

Social rhythm therapy

Question 21

Lithium induced Nephrogenic DI

Answer 21

Lithium-induced nephrogenic diabetes insipidus is usually a self-limiting condition in which there is a down-regulation of channel aquaporin-2 in the luminal wall of the cell’s surface, leading to decreased urine osmolality and increased urine volume (polyuria). ADH levels are adequate or even high, but its action on the V2 receptor is defective. V1-receptor is located in the vascular smooth muscles and is involved in total peripheral resistance regulation.

Question 22

Mechanism of action of depakote

Answer 22

Blocks GABA transaminase, increasing synaptic levels of GABA.

Question 23

What is cyclothymic disorder?

Answer 23

Cyclothymic disorder requires over 2 years the presence of numerous periods of both hypomanic symptoms and depressive symptoms not meeting criteria for manic or hypomanic episodes or for major depressive disorder, with symptom-free periods no longer than 2 months.

Question 24

What teratogenic effects does carbamazepine have on the fetus?

Answer 24

Craniofacial abnormalities.

Question 25

Symptoms of lithium toxicity

Answer 25

cognitive slowing, slurred speech, poor memory, and drowsiness,

Question 26

Risk factors for bipolar disorder

Answer 26

Attention-deficit/hyperactivity disorder (ADHD) and conduct disorders, aggression, and impulsivity have consistently been reported as clinical risk factors for later bipolar disorder in prospective studies

Question 27

Carbamazepine and SIADH

Answer 27

SIADH is a recognized side effect of carbamazepine (CBZ) therapy, even with therapeutic doses. Elevated CBZ levels are more likely to manifest as slurred speech, double vision, ataxia, and somnolence.

Question 28

Minimum period of time to taper and stop lithium in a maintenance patient?

Answer 28

2 weeks

Question 29

Hypothyroidism worse in regular bipolar or rapid cycling?

Answer 29

Thyroid problems are more common in the complex forms of bipolar disorder (mixed states and rapid cycling) than in classic bipolar manic patients.

Question 30

Which medication can LOWER the lithium level?

Answer 30

Acetazolamide

Question 31

What is seen in patients with manic episodes secondary to medical condition?

Answer 31

They are generally older, and more irritable.

Question 32

How many days needed for a hypomanic episode?

Answer 32

4 days

Question 33

Why do teens quit lithium? What about adults?

Answer 33

Acne. Tremor.

Question 34

What are females with bipolar more likely to have than males?

Answer 34

Females with bipolar disorder are likely to experience patterns of comorbidity different from those of males, such as higher lifetime rates of eating disorders. They also have a higher lifetime risk of developing alcohol use disorder as compared to males with bipolar disorder, as well as a greater likelihood of developing alcohol use disorder compared to females in the general population

Question 35

What med can INCREASE the dose of depakote?

Answer 35

aspirin

Question 36

Disinhibition in bipolar is a dysfunction of what part of the brain?

Answer 36

ventrolateral prefrontal cortext

Question 37

Which mood stabilizer can cause cognitive impairment at usually therapeutic dosages?

Answer 37

topiramate

Question 38

Atomoxetine and bipolar

Answer 38

caution as it can also cause manic switching

Question 39

A diagnosis of substance/medication-induced bipolar and related disorder can be assigned if mood symptoms develop within what period after the substance intoxication or withdrawal?

Answer 39

1 month

Question 40

Name bipolar brain anatomy parts impacted

Answer 40

orbitofrontal cortex

Ventrolateral prefrontal cortex: disinhibition