Bipolar disorder lect 6 Flashcards by Betsy Guillen

bipolar disorders is also known as

manic depressive disorder

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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)

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pressured speech

accelerated/uncontrolled speech that often occurs in context of hypomanic/manic episode.

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manic episode

-present at least 7 days
-impairment of social and occupational fxn
-3 + manic episodes described

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psychosis

-persons thoughts or perception are disturbed and the individual may have difficulty understanding what is real and what is not

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mixed episode

-sx of depression and mania/hypomania

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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

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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

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Bipolar MANIC EPIDOSDE 1 diagnoses:

-full manic episode during antidepressant tx but persists at full syndromal lvl BEYOND the psychological effect of tx

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the mood disturbance in sufficiently severe to cause MARKED IMPAIRM’T in social or occupational/hospitalizations:

-to prevent harm to self or to others

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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.

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bipolar major depressive episode is the same as

MDD:
where they are in depressed mood and loss of interest or pleasure

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bipolar disorder 1:
bipolar disorder 2:

-manic episodes, mixed episodes

2: hypomanic episodes

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Bipolar disorder 1:

one manic episode causing social/occupational impairment

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bipolar disorder type 2:

chronic depression with one HYPOmanic episode

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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

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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