Bipolar Disorder I, II & Cyclothymic Disorder Flashcards
What percentage of the population has Bipolar I?
1%
What is the mean age of onset of Bipolar I?
18-20 y/o
What is the one mahor risk factor of Bipolar Disorder?
Fam hx of bipolar disorder 10 fold increase
What is the etiology of Bipolar disorder?
It is unknown but likely shares some overlap with depressive disorders
Bipolar I: Criteria have been met for at least one __________. This could be preceded by and may be followed by ______ or _______ episodes
Bipolar I: Criteria have been met for at least one manic episode. This could be preceded by and may be followed by hypomanic or major depressive episodes.
Are depressive episodes required for Bipolar I diagnosis?
No
Mania in Bipolar Disorder I
abnormal and persistently elevated, expansive or irritable mood atleast 1 week
marked impairment of social/occupational function
In order to diagnose pt with Bipolar I, pt must have 3 or more of the following in categories of MOOD, THINKING, and BEHAVIOR
MOOD:
euphoria, irritable, labile or dysphoric
THINKING:
racing, flight of ideas, disorganized, easily distracted, expansions or grandiose thoughts (highly inflated self esteem). Judgement is impaired: spendng sprees.
BEHAVIOR:
physical hyperactivity, pressured speech, decreased need for sleep (may go days w/o sleep), increased impulsivity and excessive involvement in pleasurable activities including risk-taking and hypersexuality.
Disinhibition, increased goal directed activity.
Psychotic symptoms: paranoia, delusions, hallucinations.
Mood indications that pt has Bipolar I
euphoria, irritable, labile or dysphoric
THINKING indications that pt has Bipolar Disorder I
racing, flight of ideas, disorganized, easily distracted, expansions or grandiose thoughts (highly inflated self esteem). Judgement is impaired: spendng sprees.
BEHAVIOR indications that pt has Bipolar I
physical hyperactivity, pressured speech, decreased need for sleep (may go days w/o sleep), increased impulsivity and excessive involvement in pleasurable activities including risk-taking and hypersexuality.
Disinhibition, increased goal directed activity.
Psychotic symptoms: paranoia, delusions, hallucinations.
Bipolar I disorder with rapid cycling
4 mood episodes in the previous 12 months that meet criteria for manic, hypomanic, or major depressive episode
Describe a Manic Episode
Abnormally elevated, expanisive or irritable mood + 3 or 4 other symptoms
Describe a Major Depressive Episode
depressed mood or loss of interest coupled with four other symptoms
Describe a Hypomanic Episode
Elevated, expansive, or irritable mood, less severe and shorter duration than mania+ 3 or 4 symptoms
Mixed Episode
Meets criteria for both a manic episode and a major depressive episode
Main criteria for Bipolar II Disorder
1 or more hypomanic episode(s) + 1 or more major depressive episode(s)
Mania or mixed episodes are absent.
Hypomania
symptoms similar to manic symptoms: period of elevated, expansive or irritable mood at least 4 days that is clearly different from the usual nondepressed mood but DOES NOT CAUSE MARKED IMPAIRMENT, NO PSYCHOTIC FEATURES AND DOES NOT REQUIRE HOSPITALIZATION USUALLY. DOES NOT INCLUDE RACING THOUGHTS OR EXCESSIVE PSYCHOMOTOR AGITATION.
Bipolar Disorder Comorbidities
anxiety disorders
attention deficit hyperactive disorder (ADHD)
Conduct Disorder
Substance abuse disorder
Appropriate medication for managing bipolar affective disorder or manic depressive illness depends on what?
The stage of the illness the patient is experiencing
What symptoms does the choice of agent depend on?
psychotic symptoms
agitation
aggression
sleep disturbance
What are the drug categories for Bipolar Disorder?
Mood stabilizers
anticonvulsants
antipsychotics
Cyclothyma is best managed with_____________
psychotherapy
What is used for prophylaxis and treatment of manic episodes?
Lithium
Lithium is a ________
mood stabilizer
Side effects of Lithium
increased risk of urinary concentrating ability
hypothryoidism
hyperparathyroidism
weight gain
risk of end stage renal failure is low but must be kept in mind
What drug has anti suicidal action?
Lithium
What class of medicatios is carbamezepine?
Anticonvulsants
What kind of patients would you use carbamezapine on?
patients who have not had clinical response to lithium and who have rapid cycling bipolar d/o
What class of medications do Valproate sodium, valproic acid, divalproex sodium fall into?
Anticonvulsants
When would you use valproate sodium, valproic acid, divalproex sodium?
Valproate treats mania
You can use these alone or in combination with lithium
useful for rapid cycling bipolar d/o
also used to treat aggressive or behavioral d/o
What class of meds do Quetiapine and Risperidone fall under?
Antipsychotics
When would you use Quetiapine?
acute treatment of manic or mixed episodes in bipolar I disorder
they come in immediate and extended release
can be used as monotherapy or with lithium or divalproex
When would you use Risperidone?
short term treatment of acute manic or mixed episodes in bipolar I disorder
can be used alone or in combination with lithium or valproate
can be used in adults and adolescents 10-17 years old with bipolar I
Meds used for manic phase of Bipolar
Mood stabilizer
- lithium
- divalproex
- carbamazepine
AND/OR
Atypical Antipsychotic
- risperidone
- quetiapine
Meds used in Depressed phase of BP
Mood stabilizer and/or atypical antipsychotic and/or antidepressant
Meds used for maintenance
Lithium (mood stabilizer)
quetiapine/ risperidone (Atypical Antipsychotics)
Define cyclothymic disorder
characterized by mood swings between hypomania and dysthmia but without any full manic or major depressive episodes
For atleast 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that DO NOT MEET criteria for a hypomanic episode and numerous periods with depressive symptoms that DO NOT MEET criteria for a major depressive episode. What disorder is this?
Cyclothymic Disorder
Additional criteria for cyclothymic disorder
during a 2 year period, hypomanic and depressive periods have been present for atleast half the time and the individual has not been without the symptoms for more than 2 months.
criteria for MDD, manic or hypomanic episodes have never been met.
What screens for Bipolar Spectrum Disorder?
Mood Disorder Questionnaire
Requirements for a positive bipolar screen
“yes” to 7 or more of the 13 items under question 1
AND
“yes” to “if you checked YES to more than one of the above, have several of these ever happened during the same period of time?”
AND
“moderate” or “serious” to “how much of a problem did any of these cause you-like being unable to work; having family, money or legal troubles; getting into arguements or fights?”
