Bipolar Disorder and Tx Flashcards
What is the difference between mania and hypomania?
What are some general terms that are often used to describe hypomania and mania
Hypomania:
- brief duration (at least 4 days) of less severe manic sx
- mild functional impairment, can even improve functioning
- no psychosis
Mania:
- longer duration (at least 1wk) andd more severe sx
- psychosis can occur
- significant impairment
- often leads to hospitilization
Terms:
Hypomania: decreased need for slleep, grandiosity or inflated self-esteem, increase in goal directed activity, flight of ideas.
Mania: decreased need for sleep, grandiosity of inflated sel-esteem, pressured speech, injudicious impulsive behavior
What are the types of bipolar? describe each.
Bipolar 1: hx of at least one manic episode with our without past major depressive episodes
Bipolar 2: hx of at least one major depressive episode and at least one hypomanic episode. *NO hx of manic episode.
Define a manic episode
- a period of abnormally and persistently elevated or irritable mood lasting at least 1wk.
- -inflated self-esteem, grandiosity, decreased need for sleep, more talkative than usual/pressured speech, flight of ideas, distractability, increase in goal-directed activity, excessive involvement in pleasurable activities that have high potential for consequences
*mood disturbance must be severe enough to cause marked impairment in all aspects of life, necessitates hospitalization to prevent harm to self or others, or has psychotic features.
Describe hypomanic episode.
- a period of abnormally and persistently elevated or irritable mood lasting at least 4 consecutive days and present most of the day nearly everyday.
- -inflated self-esteem, grandiosity, decreased need for sleep, more talkative than usual/pressured speech, flight of ideas, distractability, increase in goal-directed activity, excessive involvement in pleasurable activities that have high potential for consequences
*episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. NO psychotic features.
What is the usual age at onset of bipolar? Is bipolar more common in men or women?
Is bipolar genetic?
Age at onset: 15-30
Bipolar 1: men=women
Bipolar 2: MC in women
extremely genetic. Genes 18Q and 22Q are thought to have the strongest link to bipolar.
Describe the clinical course of Bipolar 1.
Describe clinical course of Bipolar II
Bipolar I = Manic.
relapses and remissions, alternating patter between manic(at least 1wk) and depressive episodes(2 wks) (3:1)
90% who have one manic episode have another in 5 years
*depressive sx are MC than manic
Bipolar II = hypomanic
- depressive (2wks) sx are much more frequent than hypomanic(4 days) episodes (37:1)
- greatest risk of attempting and completing suicide.
What is “Mixed State”?
this refers to the presence of both depressive and manic sx simultaneously.
person may experience the impulsiveness, insomnia, irritability, and flight of ideas that can be present in a manic episode as well as suicidal thoughts, guilt, feelings of hopelessness, changes of appetite that are common during depressive episodes.
What is Cyclothymia?
presence of numerous periods of hypomania and of depression persisting for at least 2 years.
*dont meet requirements for Major depressive episodes or mania, but meets requirements for hypomania.
What two labs are important to check when pt presents with mania or hypomania?
Toxicology and thyroid function tests!! because substance induced mood disorders and hyperthyroidism can mimic the signs of mania.
Can bipolar patients be put on anti-depressants?
NO!! that will induce mania!
WHat classes of medications treat the sx of bipolar?
Mood stabilizers & 1st and 2nd generation Antipsychotics
What are the mood stabilizing agents?
What are the general SE of mood stabilizing agents?
Lithium, Valproate (depakote), carbamazepine (Tegretol)
SE:
-drowsiness, dizziness, HA, diarrhea, constipation, heartburn, mood swings, stuffed or runny nose.
Lithium
- high or low therapeutic index? When do we draw levels to recheck concentration of drug?
- What labs do we need to routinely monitor?
- what are the MC SE associated with this drug?
low therapeutic index = you dont need a lot to make a lot of effects.
always draw levels 12hrs after the last dose.
Need to monitor liver, Kidneys and thyroid!!
MC SE are weight gain and edema.
Valproate (Depakote)
- how does this compare to lithium?
- what labs do we need to check?
- MC SE?
- worry about what things happening?
may be used as 1st line tx for mania, SE profile less than that of lithium.
Labs: LFTs, platelets, thyroid
MC SE: weight gain, N/V, hair loss, tremors*(not as significant as lithium)
Worry about pancytopenia, pancreatitis, and hepatic failure.
Carbamazepine (Tegretol)
- SE
- Labs
SE: N/V, hyponatremia*, Rash (SJS), drowsiness, blurred vision, blood dyscrasias.
Labs: LFT, CBC, serum Na, thyroid
