Bipolar disorder lect 6 Flashcards
bipolar disorders is also known as
manic depressive disorder
the definition of mania
-inflated self esteem/grandiosity
-decreased need for sleep
-pressured speech/talkative
-racing thoughts
-distractibility
-hyperactivity with increase goal directed actions or agigtiation w non goal directed actions
-excessive involvement in activites w painful consequences ( such as spending alot)
pressured speech
accelerated/uncontrolled speech that often occurs in context of hypomanic/manic episode.
manic episode
-present at least 7 days
-impairment of social and occupational fxn
-3 + manic episodes described
psychosis
-persons thoughts or perception are disturbed and the individual may have difficulty understanding what is real and what is not
mixed episode
-sx of depression and mania/hypomania
hypomanic episode :
-like a manic episode EXCEPT:
-duration is 4 days
-does NOT cause social or occupational impairment
-does not require hospitilization
-does not have psychotic features
Bipolar DSM-5
meet the criteria of manic episodes:
-distinct pd. of irritability mood and increased of active energy
-during the period of mood disturbance and high energy activity, 3+ of sx are present [4 if irritable]:
-inflated self esteem
-decrease need for sleep
-more talkative than usual
-flight of racing ideas
-distracted easily
-increase in goal activity
-excessive involv’t of activities with painful consequences
Bipolar MANIC EPIDOSDE 1 diagnoses:
-full manic episode during antidepressant tx but persists at full syndromal lvl BEYOND the psychological effect of tx
the mood disturbance in sufficiently severe to cause MARKED IMPAIRM’T in social or occupational/hospitalizations:
-to prevent harm to self or to others
HYPOMANIC bipolar dsm-5 c-f:
-unequivocal change in fxning that is uncharacteristic of the individual when not symptomatic.
-disturbance in mood and change in fxning are observed by others
-not attributed to psychological effects of a substance
-caution is indicated for those on antidepressants effects that can cause mani c episodes so they are not taken sufficient for diagnosis.
bipolar major depressive episode is the same as
MDD:
where they are in depressed mood and loss of interest or pleasure
bipolar disorder 1:
bipolar disorder 2:
-manic episodes, mixed episodes
2: hypomanic episodes
Bipolar disorder 1:
one manic episode causing social/occupational impairment
bipolar disorder type 2:
chronic depression with one HYPOmanic episode
cyclothymic disorder
recurrent hypomanic disorders or depressive sx but NEVER meet criteria of manic or depressive episodes, span of 2 yrs and never absent for more than 2 months at a time
GAD
related to hypomania BUT more EMPHASIZES ON WORRY
Depressive disorder
depressed or anhedonic mood
PTSD
hx of trauma and severe anxiety
psychotic disorder
hallucinations and or delusions
substance use disorder
possible mania or depression, linked to substance
borderline personality disorder
sx similiar to mania, hypomania, or depressed mood
medical conditions that mimic BIPOLAR disorder:
-uncontrolled thyroid
-frontal lobe pathology: [tumors, injury, cogenital defects]
-medications :thyroxine, corticosteroids ,isoniazid, levodopa
medications that mimic bipolar disorder
-thyroxine
-corticosteroids
-isoniazid
-levodopa
bipolar disorder:
age?
race?
percent?
-20-30 yrs old
-NA-white-AA-hispan.-asian
1.5%
risk in first degree relative is 5-10%
pharmacological tx:
mood stabilizers
-lithium
-lamotrigine
-divalproex
-carbamazepine
pharmacological tx:
Atypical antipsychotics
-quetiapine
-risperidone
-aripiprazole
-ziprasidone
-olanzapine
Lithium
-best bipolar tx
-reduces risk of suicide
-narrow therapeutic window for side affects such as : nausea, sleepy, slurred speech, confusion,
lithium SA:
long term:
SA: polyuria, polydipsia, tremor, weight gain, edema
-teratogen:
ebsten anomaly:malposiiotn of the tricuspid valve
FDA approved what med. for monotherapy:
-quetiapine XR
-seroquel XR
suicide:
global# deaths
U.S deaths:
% of attempt
-800,000
-18th leading cause of death
-US- 40,000
5% will have attempted
20-30:1 Ratio
males and female suicide statistics:
ethnicity:
-males use deadlier means
females: greater number of doses
NA>white> hisp.>AA
avg. age of death in suicide
what is the 2 nd leading cause of death for ages 15-34?
males >75
f: 45-64
suicide
Suicide risk factors
-recent loss of spouse, child, job
-worsening of dx: mental, substance abuse, health cond
adverse life event:
bullied, break up, arrest
suicide protect factors:
-social support system, religious affiliation, married, children
screening for suicide:
-PHQ9
-* P4 screener:pasthx, plan, probabiltiy, preventative factors
suicide intervention/prevention:
-ask empathetically
-about their specific plans, harmful ideas will to live
if pt has a plan and is certain about suicide, you must:
-immediate referral to psychiatric eval
-inpatient ED
-CAN BE AGAINST PT WILL
certificate of emergency 6404:
-emergent INVOLUNTARY admission
1st part: put pt in psychiatric facilty then admit to ed, TX is NECESSARY
45% of pts commit suicide who seen health care provider last month
