Bipolar Disorder I, II & Cyclothymic Disorder

Question 1

What percentage of the population has Bipolar I?

Answer 1

1%

Question 2

What is the mean age of onset of Bipolar I?

Answer 2

18-20 y/o

Question 3

What is the one mahor risk factor of Bipolar Disorder?

Answer 3

Fam hx of bipolar disorder 10 fold increase

Question 4

What is the etiology of Bipolar disorder?

Answer 4

It is unknown but likely shares some overlap with depressive disorders

Question 5

Bipolar I: Criteria have been met for at least one __________. This could be preceded by and may be followed by ______ or _______ episodes

Answer 5

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.

Question 6

Are depressive episodes required for Bipolar I diagnosis?

Answer 6

No

Question 7

Mania in Bipolar Disorder I

Answer 7

abnormal and persistently elevated, expansive or irritable mood atleast 1 week

marked impairment of social/occupational function

Question 8

In order to diagnose pt with Bipolar I, pt must have 3 or more of the following in categories of MOOD, THINKING, and BEHAVIOR

Answer 8

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.

Question 9

Mood indications that pt has Bipolar I

Answer 9

euphoria, irritable, labile or dysphoric

Question 10

THINKING indications that pt has Bipolar Disorder I

Answer 10

racing, flight of ideas, disorganized, easily distracted, expansions or grandiose thoughts (highly inflated self esteem). Judgement is impaired: spendng sprees.

Question 11

BEHAVIOR indications that pt has Bipolar I

Answer 11

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.

Question 12

Bipolar I disorder with rapid cycling

Answer 12

4 mood episodes in the previous 12 months that meet criteria for manic, hypomanic, or major depressive episode

Question 13

Describe a Manic Episode

Answer 13

Abnormally elevated, expanisive or irritable mood + 3 or 4 other symptoms

Question 14

Describe a Major Depressive Episode

Answer 14

depressed mood or loss of interest coupled with four other symptoms

Question 15

Describe a Hypomanic Episode

Answer 15

Elevated, expansive, or irritable mood, less severe and shorter duration than mania+ 3 or 4 symptoms

Question 16

Mixed Episode

Answer 16

Meets criteria for both a manic episode and a major depressive episode

Question 17

Main criteria for Bipolar II Disorder

Answer 17

1 or more hypomanic episode(s) + 1 or more major depressive episode(s)

Mania or mixed episodes are absent.

Question 18

Hypomania

Answer 18

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.

Question 19

Bipolar Disorder Comorbidities

Answer 19

anxiety disorders

attention deficit hyperactive disorder (ADHD)

Conduct Disorder

Substance abuse disorder

Question 20

Appropriate medication for managing bipolar affective disorder or manic depressive illness depends on what?

Answer 20

The stage of the illness the patient is experiencing

Question 21

What symptoms does the choice of agent depend on?

Answer 21

psychotic symptoms

agitation

aggression

sleep disturbance

Question 22

What are the drug categories for Bipolar Disorder?

Answer 22

Mood stabilizers

anticonvulsants

antipsychotics

Question 23

Cyclothyma is best managed with_____________

Answer 23

psychotherapy

Question 24

What is used for prophylaxis and treatment of manic episodes?

Answer 24

Lithium

Question 25

Lithium is a ________

Answer 25

mood stabilizer

Question 26

Side effects of Lithium

Answer 26

increased risk of urinary concentrating ability

hypothryoidism

hyperparathyroidism

weight gain

risk of end stage renal failure is low but must be kept in mind

Question 27

What drug has anti suicidal action?

Answer 27

Lithium

Question 28

What class of medicatios is carbamezepine?

Answer 28

Anticonvulsants

Question 29

What kind of patients would you use carbamezapine on?

Answer 29

patients who have not had clinical response to lithium and who have rapid cycling bipolar d/o

Question 30

What class of medications do Valproate sodium, valproic acid, divalproex sodium fall into?

Answer 30

Anticonvulsants

Question 31

When would you use valproate sodium, valproic acid, divalproex sodium?

Answer 31

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

Question 32

What class of meds do Quetiapine and Risperidone fall under?

Answer 32

Antipsychotics

Question 33

When would you use Quetiapine?

Answer 33

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

Question 34

When would you use Risperidone?

Answer 34

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

Question 35

Meds used for manic phase of Bipolar

Answer 35

Mood stabilizer

• lithium
• divalproex
• carbamazepine

AND/OR

Atypical Antipsychotic

• risperidone
• quetiapine

Question 36

Meds used in Depressed phase of BP

Answer 36

Mood stabilizer and/or atypical antipsychotic and/or antidepressant

Question 37

Meds used for maintenance

Answer 37

Lithium (mood stabilizer)

quetiapine/ risperidone (Atypical Antipsychotics)

Question 38

Define cyclothymic disorder

Answer 38

characterized by mood swings between hypomania and dysthmia but without any full manic or major depressive episodes

Question 39

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?

Answer 39

Cyclothymic Disorder

Question 40

Additional criteria for cyclothymic disorder

Answer 40

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.

Question 41

What screens for Bipolar Spectrum Disorder?

Answer 41

Mood Disorder Questionnaire

Question 42

Requirements for a positive bipolar screen

Answer 42

“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?”