Bipolar Disorder, including treatment

Question 1

What is required for a diagnosis of bipolar disorder?

Answer 1

Bipolar I: at least 1 manic episode (>1wk)

Bipolar II: can include depressive and hypomanic episodes (no true mania)

Question 2

Kid comes into college student clinic w/o psych hx and is clearly depressed. What do you consider before prescribing SSRI or some other antidepressant?

Answer 2

if he has bipolar disorder, this could facilitate a transition from depression to mania.

Question 3

What is cyclothymic disorder?

Answer 3

2 years of mild hypomania and mild depressive symptoms. normal mood

Question 4

What is the diagnostic criteria for a manic episode?

Answer 4

3/7. >1wk, impairs functioning
DIG FAST
distractibility
irresponsibility
grandiosity
flight of ideas
activity increase or agitation
decreased need for sleep
talkative, loud, pressured speech

Question 5

What qualifies as a hypomanic episode?

Answer 5

> 4 days
doesn’t impair functioning
some of the manic features, but no psychosis

Question 6

Which mood stabilizers can be used to treat bipolar disorder?

Answer 6

Lithium
Atypical Antipsychotics: risperidone, aripiprazole, olanzapine
Anti-epileptics: Lamotrigine, Carbamazepine, Valproic Acid

Question 7

Aside from bipolar disorder, what else can lithium be used to treat?

Answer 7

SIADH
b/c it inhibits the effects of ADH
Note: this can also be a bad side effect (causing nephrogenic diabetes insipidus)

Question 8

What are the SE of Lithium Use?

Answer 8

LMNOP
Movement (tremor)
Nephrogenic Diabetes Insipidus
hypOthyroidism or goiter
Pregancy teratogen--Ebstein anomaly
**other: sedation, dizziness
Heart: sick sinus syndrome, bradycardia, arrhythmias (heart block)

Question 9

Where is lithium excreted? Which drug can cause lithium toxicity?

Answer 9

excreted by kidneys
most of it is reabsorbed at PCT w/ Na+
thiazide diuretics, ACE inhibitors, NSAIDs use can cause toxicity (not loop diuretics)