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Behavioral Health > Bipolar Disorders > Flashcards

Bipolar Disorders Flashcards

1
Q

What is the strongest risk factor for Bipolar I?

A

Family history of a first degree relative

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2
Q

What gender is Bipolar I more common in?

A

Male

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3
Q

The ____ the onset of Bipolar I, the greater likelihood of _____features and the ______the prognosis

A

Earlier, psychotic, poorer

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4
Q

Diagnostic criteria for Bipolar I:

A

At least 1 manic or mixed episode

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5
Q

Are major depressive episodes required for diagnosis of BPD1?

A

No

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6
Q

Mania criteria:

  1. 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

A

elevated, expansive or irritable mood

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7
Q

Mania criteria:

  1. 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

A

one week

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8
Q

Mania criteria:

  1. 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

A

hospitalization is required

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9
Q

Mania criteria:

  1. 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

A

impairment of social/occupational functioning

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10
Q

Mania criteria:

  1. 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

A

at least three characteristics of

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11
Q

Mania criteria:

  1. 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

A

-Mood
-Thinking
-Behavior

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12
Q

Mania criteria:

  1. 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
______

A

-Not due to medical condition or substance use

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13
Q

Are psychotic symptoms present in mania?

A

Can or cannot be

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14
Q

What are mood sxs of mania? (4)

A
  1. Euphoria
  2. Irritable
  3. Labile
  4. Dysphoric
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15
Q

What are thinking changes of mania (5)

A
  1. Racing
  2. Flight of ideas
  3. Disorganized
  4. Easily distracted
  5. Expansive or grandiose (highly inflated self esteem)
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16
Q

What are behavior changes of mania? (5)

A
  1. Physical hyperactivity
  2. Pressured speech
  3. Decreased need for sleep
  4. Increased impulsivity
  5. Excessive involvement in pleasurable activities
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17
Q

What are pleasurable activity types that may increase in mania? (4)

A
  1. risk taking
  2. sexuality
  3. disinhibition
  4. goal directed
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18
Q

What are types of psychotic symptoms possible in BPD? (3)

A
  1. Paranoia
  2. Hallucinations
  3. Delusions
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19
Q

What is first line for Bipolar 1

A

Mood stabilizers (Lithium)

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20
Q

What can be used for rapid cycling or mixed features in BPD 1?

A

Valproi acid of Carbamezapine

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21
Q

What drug class besides mood stabilizers can be used as mono or adjunct therapy in BPD?

A

2nd generation antipsychotics

22
Q

What are the main 2nd gen antipsychotics? (4)

A
  1. Risperidone
  2. Quetiapine
  3. Olanzapine
  4. Ziprasidone
23
Q

______ and ______ should be added to pharm therapy in BPD 1

A

Psychotherapy and good sleep hygiene

24
Q

What four meds are good for bipolar depression?

A
  1. Lithium
  2. Quetiapine
  3. Lurasidone
  4. Lamotrigine
25
Q

What is the indication for antideppresents in BPD?

A

Can be used as adjunct therapy, but as monotherapy may precipitate mania

26
Q

What meds are indicated for acute mania in BPD?

A

Antipsychotics
1. Risperidone
2. Olanzapine
3. Haldol (less preferred)
OR
Mood stabilizers
-Lithium / Valproic acid

27
Q

Antipsychotics or ________ can be used for acute psychosis or agitation in BPD

A

Benzos

28
Q

_________ _________ can be used to treat refractory or life threatening acute mania or depression

A

Electroconvulsive therapy

29
Q

ECT is best tx for ______ with manic episodes

A

Pregnant women

30
Q

What is the MOA of Lithium

A

Unknown, but thought to alter neuronal sodium transport and influence reuptake of serotonin and/or norepi

31
Q

What three conditions is Lithium indicated for?

A
  1. Bipolar Disorder (manic and depressive episodes)
  2. Acute mania (mood stabilizer)
  3. Schizoaffective disorder
32
Q

What are the adverse endocrine of Lithium? (6)

A
  1. Hypothyroid
  2. Nephrogenic diabetes insipidus
  3. Hyperparathyroidism
  4. Hypercalcemia
  5. Hypermagnesemia
  6. Sodium depletion
33
Q

What are the neuro AEs of lithium? (4)

A
  1. Seizures
  2. Tremor
  3. HA
  4. Sedation
34
Q

What are the GI AEs of lithium?

A

-N/V/D
-Weight gain

35
Q

What are the two other systemic AEs of lithium?

A

-Arrhythmias
-Leukocytosis

36
Q

Why should you complete the following work up before starting lithium? -ECG, chemistries, thyroid function, beta-hCG and CBC?

A

Narrow therapeutic index

37
Q

How do you monitor lithium after initiation?

A

Levels after five days, then every 2-3 days until therapeutic. Once therapeutic, every 4-8 weeks

38
Q

What level of lithium may be toxic?

A

> 1.5

39
Q

When is lithium contraindicated? (3)

A
  1. Pregnancy
  2. Severe renal disease
  3. Cardiac disease
40
Q

What can lithium cause if administered in pregnancy?

A

Ebsteins anomaly

41
Q

What meds do you need to be cautious about in concurrence with lithium? (3)

A
  1. NSAIDS
  2. ACEI
  3. Thiazide diuretics
42
Q

Impaired renal function can ____ lithium levels

A

Increase

43
Q

What is Bipolar II disorder?

A

Recurrent major depressive episodes with hypomania

44
Q

What is the diagnostic criteria for BPD II?

A

History of at least 1 major depressive episode and at least 1 hypomanic episode

45
Q

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

A

persistently elevated, expansive or irritable mood

46
Q

-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

A

< 1 week

47
Q

-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

A

require hospitalization

48
Q

-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

A

impair social / occupational function

49
Q

-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

A

psychotic features

50
Q

-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 _________

A

affecting mood, thinking or behavior

51
Q

What is treatment for BPD II?

A

Same as BPD I:
-Mood stabilizers or second gen antipsychotics
-Valproic acid or Carbamezepine for rapid cycling
-Psychotherapy and sleep hygiene

Behavioral Health (19 decks)

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