Bipolar Disorders Flashcards
What is the strongest risk factor for Bipolar I?
Family history of a first degree relative
What gender is Bipolar I more common in?
Male
The ____ the onset of Bipolar I, the greater likelihood of _____features and the ______the prognosis
Earlier, psychotic, poorer
Diagnostic criteria for Bipolar I:
At least 1 manic or mixed episode
Are major depressive episodes required for diagnosis of BPD1?
No
Mania criteria:
- Abnormal & persistently _____, _____ or _____ at least one week (or less if hospitalization is required) with marked impairment of social/occupational functioning and at least three characteristics of
-Mood
-Thinking
-Behavior
-With or without psychotic symptoms
-Not due to medical condition or substance use
elevated, expansive or irritable mood
Mania criteria:
- Abnormal & persistently elevated, expansive or irritable mood at least _________ (or less if hospitalization is required) with marked impairment of social/occupational functioning and at least three characteristics of
-Mood
-Thinking
-Behavior
-With or without psychotic symptoms
-Not due to medical condition or substance use
one week
Mania criteria:
- Abnormal & persistently elevated, expansive or irritable mood at least one week (or less if _________) with marked impairment of social/occupational functioning and at least three characteristics of
-Mood
-Thinking
-Behavior
-With or without psychotic symptoms
-Not due to medical condition or substance use
hospitalization is required
Mania criteria:
- Abnormal & persistently elevated, expansive or irritable mood at least one week (or less if hospitalization is required) with marked_________ and at least three characteristics of
-Mood
-Thinking
-Behavior
-With or without psychotic symptoms
-Not due to medical condition or substance use
impairment of social/occupational functioning
Mania criteria:
- Abnormal & persistently elevated, expansive or irritable mood at least one week (or less if hospitalization is required) with marked impairment of social/occupational functioning and _______
-Mood
-Thinking
-Behavior
-With or without psychotic symptoms
-Not due to medical condition or substance use
at least three characteristics of
Mania criteria:
- Abnormal & persistently elevated, expansive or irritable mood at least one week (or less if hospitalization is required) with marked impairment of social/occupational functioning and at least three characteristics of
__________
-With or without psychotic symptoms
-Not due to medical condition or substance use
-Mood
-Thinking
-Behavior
Mania criteria:
- Abnormal & persistently elevated, expansive or irritable mood at least one week (or less if hospitalization is required) with marked impairment of social/occupational functioning and _______
-Mood
-Thinking
-Behavior
-With or without psychotic symptoms
______
-Not due to medical condition or substance use
Are psychotic symptoms present in mania?
Can or cannot be
What are mood sxs of mania? (4)
- Euphoria
- Irritable
- Labile
- Dysphoric
What are thinking changes of mania (5)
- Racing
- Flight of ideas
- Disorganized
- Easily distracted
- Expansive or grandiose (highly inflated self esteem)
What are behavior changes of mania? (5)
- Physical hyperactivity
- Pressured speech
- Decreased need for sleep
- Increased impulsivity
- Excessive involvement in pleasurable activities
What are pleasurable activity types that may increase in mania? (4)
- risk taking
- sexuality
- disinhibition
- goal directed
What are types of psychotic symptoms possible in BPD? (3)
- Paranoia
- Hallucinations
- Delusions
What is first line for Bipolar 1
Mood stabilizers (Lithium)
What can be used for rapid cycling or mixed features in BPD 1?
Valproi acid of Carbamezapine
What drug class besides mood stabilizers can be used as mono or adjunct therapy in BPD?
2nd generation antipsychotics
What are the main 2nd gen antipsychotics? (4)
- Risperidone
- Quetiapine
- Olanzapine
- Ziprasidone
______ and ______ should be added to pharm therapy in BPD 1
Psychotherapy and good sleep hygiene
What four meds are good for bipolar depression?
- Lithium
- Quetiapine
- Lurasidone
- Lamotrigine
What is the indication for antideppresents in BPD?
Can be used as adjunct therapy, but as monotherapy may precipitate mania
What meds are indicated for acute mania in BPD?
Antipsychotics
1. Risperidone
2. Olanzapine
3. Haldol (less preferred)
OR
Mood stabilizers
-Lithium / Valproic acid
Antipsychotics or ________ can be used for acute psychosis or agitation in BPD
Benzos
_________ _________ can be used to treat refractory or life threatening acute mania or depression
Electroconvulsive therapy
ECT is best tx for ______ with manic episodes
Pregnant women
What is the MOA of Lithium
Unknown, but thought to alter neuronal sodium transport and influence reuptake of serotonin and/or norepi
What three conditions is Lithium indicated for?
- Bipolar Disorder (manic and depressive episodes)
- Acute mania (mood stabilizer)
- Schizoaffective disorder
What are the adverse endocrine of Lithium? (6)
- Hypothyroid
- Nephrogenic diabetes insipidus
- Hyperparathyroidism
- Hypercalcemia
- Hypermagnesemia
- Sodium depletion
What are the neuro AEs of lithium? (4)
- Seizures
- Tremor
- HA
- Sedation
What are the GI AEs of lithium?
-N/V/D
-Weight gain
What are the two other systemic AEs of lithium?
-Arrhythmias
-Leukocytosis
Why should you complete the following work up before starting lithium? -ECG, chemistries, thyroid function, beta-hCG and CBC?
Narrow therapeutic index
How do you monitor lithium after initiation?
Levels after five days, then every 2-3 days until therapeutic. Once therapeutic, every 4-8 weeks
What level of lithium may be toxic?
> 1.5
When is lithium contraindicated? (3)
- Pregnancy
- Severe renal disease
- Cardiac disease
What can lithium cause if administered in pregnancy?
Ebsteins anomaly
What meds do you need to be cautious about in concurrence with lithium? (3)
- NSAIDS
- ACEI
- Thiazide diuretics
Impaired renal function can ____ lithium levels
Increase
What is Bipolar II disorder?
Recurrent major depressive episodes with hypomania
What is the diagnostic criteria for BPD II?
History of at least 1 major depressive episode and at least 1 hypomanic episode
Hypomania:
-Abnormal and ___________ < 1 week
-Does not require hospitalization
-Does not impair social / occupational function
-No psychotic features
-At least three symptoms affecting mood, thinking or behavior
persistently elevated, expansive or irritable mood
-Abnormal and persistently elevated, expansive or irritable mood _______
-Does not require hospitalization
-Does not impair social / occupational function
-No psychotic features
-At least three symptoms affecting mood, thinking or behavior
< 1 week
-Abnormal and persistently elevated, expansive or irritable mood < 1 week
-Does not __________
-Does not impair social / occupational function
-No psychotic features
-At least three symptoms affecting mood, thinking or behavior
require hospitalization
-Abnormal and persistently elevated, expansive or irritable mood < 1 week
-Does not require hospitalization
-Does not _________
-No psychotic features
-At least three symptoms affecting mood, thinking or behavior
impair social / occupational function
-Abnormal and persistently elevated, expansive or irritable mood < 1 week
-Does not require hospitalization
-Does not impair social / occupational function
-No __________
-At least three symptoms affecting mood, thinking or behavior
psychotic features
-Abnormal and persistently elevated, expansive or irritable mood < 1 week
-Does not require hospitalization
-Does not impair social / occupational function
-No psychotic features
-At least three symptoms _________
affecting mood, thinking or behavior
What is treatment for BPD II?
Same as BPD I:
-Mood stabilizers or second gen antipsychotics
-Valproic acid or Carbamezepine for rapid cycling
-Psychotherapy and sleep hygiene
