Bipolar Disorders

Question 1

criteria for manic episodes of bipolar disorder

Answer 1

*abnormally and persistently elevated, expansive, or irritable mood for at least 1 week
*inflated self esteem or grandiosity
*decreased need for sleep
*pressured speech
*flight of ideas or racing thoughts
*distractibility
*increase in goal-directed activity or psychomotor agitation
*excessive involvement in pleasurable activities that have a high potential for painful consequences (hypersexual, driving fast, spending lots of money)

Question 2

symptom domains of bipolar disorder

Answer 2

*manic mood and behavior
*dysphoric or negative mood and behavior
*psychotic symptoms (delusions or hallucinations)
*thought disorder

Question 3

bipolar disorder - overview

Answer 3

*onset in young adulthood
*chronic episodic course
*significant morbidity & mortality
*onset to proper dx: 3-10 years
*family history increases risk

Question 4

bipolar disorder - type I

Answer 4

*must have a manic episode (elevated, expansive, irritable mood with accompanying DIGFAST symptoms for at least a week)
*manic episode leads to marked impairment in function or there are psychotic features
*severe depressive episodes also occur

Question 5

DIGFAST symptoms for bipolar disorder

Answer 5

D - distractibility
I - insomnia
G - grandiosity
F - flight of ideas
A - activities
S - speech
T - thoughtlessness

Question 6

mood disorder questionnaire

Answer 6

most commonly used screening questionnaire for bipolar disorder

Question 7

bipolar disorder II

Answer 7

*HYPOMANIC episode (milder form of mania) = DIGFAST symptoms but no psychotic features, not severe enough to cause marked impairment in function or hospitalization
*elevated, expansive, irritable mood for 4 days
*episode of major depression

Question 8

rapid cycling bipolar disorder

Answer 8

*at least 4 episodes per year
*more common in females than males

Question 9

cyclothymic disorder

Answer 9

*hypomanic + mild depressive symptoms (2 years)
*1/3 progress to bipolar II
*comorbid substance abuse, borderline

Question 10

secondary causes of mania

Answer 10

*substance-induced mood disorder (meth, cocaine, steroids, etc)
*mood disorder due to a general medical condition (MS, trauma, AIDS, etc)

Question 11

bipolar disorder pathophysiology

Answer 11

*decreased activity in ventrolateral prefrontal cortex leading to trouble with volitional affect regulation
*decreased activity in dorsilateral prefrontal cortex leading to trouble with executive function
*abnormalities in anterior cingulate cortex leading to trouble with affect regulation
*smaller hippocampal volume
*smaller amygdala volume, leading to difficulty with assessment and interpretation of emotion and disproportionate emotional response

Question 12

treatment options for bipolar disorder

Answer 12

*psychotherapy: CBT, interpersonal
*mood stabilizers +/- antipsychotics or benzos
*ECT (electroconvulsive therapy) for severe depression or psychosis
*combination psychotherapy + medications = best!!!

Question 13

challenges of bipolar disorder

Answer 13

*complexity of the clinical presentation
*recognition of bipolar depression
*lack of adherence to treatment
*necessity of phase-relevant treatment strategy

Question 14

lithium - clinical precautions

Answer 14

*excretion affected by water and salt metabolism (exercise, caffeine, diuretics, etc)
*ADEs:
-neurocognitive (memory, tremor)
-renal (diabetes insipidus)
-endocrine (thyroid, parathyroid)
-dermatologic (cystic acne)
-fetal (Ebstein’s Anomaly)

Question 15

valproate - clinical precautions

Answer 15

*interaction with lamotrigine
*ADEs:
-neurocognitive (memory, tremor)
-GI: hepatotoxicity, pancreatitis
-hematologic: thrombocytopenia
-weight gain
-fetal: Neural Tube Defects (teratogenic)

Question 16

carbamazepine - clinical precautions

Answer 16

*lots of drug interactions
*lots of side effects

Question 17

lamotrigine - clinical precautions

Answer 17

*drug-drug interactions with valproate or carbamazepine
*Stevens-Johnson syndrome