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Case Files Psychiatry > Bipolar Disorders > Flashcards

Bipolar Disorders Flashcards

1
Q

What does the AACAP recommend for mood stabilizers?

A

Lithium- Only drug with FDA approval for treatment in children 12+
Divalproex- Better choice for children

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2
Q

What atypical antipsychotics are recommended by the AACAP for use a monotherapy for Bipolar I disorder?
(If no psychosis is present)

A

Olanzapine
Quetiapine
Risperidone

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3
Q

What are the medications of choice if the a bipolar child manic, but not psychotic?

A

Lithium or divalproex

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4
Q

How do children with Bipolar disorder most often present?

A

Mixed or dysphoric picture with short periods of intense mood lability and irritability

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5
Q

What is bipolar type I disorder?

A

Complete manic symptoms occur

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6
Q

What is bipolar type II disorder?

A

Depression and hypomania

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7
Q

What is hypomania?

A

Similar symptoms as mania just to a lesser degree
Elevated, expansive, or irritable mood
Increased activity or energy

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8
Q

What aspects are NOT a part of hypomania?

A

Psychotic symptoms
Racing thoughts
Marked psycomotor agitation

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9
Q

What is rapid-cycling bipolar disorder?

A

4 mood episodes- Retarded depression or hypomania/mania
All occuring within one year
Requires full or partial remission of at least 2 months or a full switch from one pole to the other

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10
Q

What does labile mean?

A

Rapidly switching from one extreme to another

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11
Q

What is controversial about the way children with bipolar disorder may present?

A

Severe mood dysregulation

  • Multiple, intense, prolonged mood swings or temper outbursts
  • Short periods of euphoria
  • Long periods of irritability
  • 3 to 4 cycles per day
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12
Q

What is the basic criteria for diagnosis bipolar disorder?

A

Abnormally and persistently elevated, expansive, or irritable mood
Persistent increased energy
Must last at least 1 week unless hospitilzation is required

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13
Q

What are some of additionall (at least 3) criteria taht are needed to make a diagnosis of bipolar disorder?

A

Inflated self-esteem or grandiosity
Decreased need for sleep
Talkativeness or pressured speech
Flight of ideas or racing thoughts
Distractability
Goal-directed activity or psychomotor agitation
Excessive involvement in high-risk pleasurable activities

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14
Q

What are some potential high-risk and pleasurable activities?

A

Spending spree
Sexual activity
Foolish investments

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15
Q

The AACAP recommed that what two criteria must definitely be met before a diagnosis of bipolar disorder can be made?

A

1 week of manic symptoms

2 weeks of major depression

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16
Q

What is the concordance rate for bipolar disorder between identical twins?

A

69%

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17
Q

Why is bipolar I disorder rarely diagnosed prior to puberty?

A

MDD usually presents first with mania coming after puberty

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18
Q

What are the most common signs of bipolar I seen in an adolescent?

A

Grandiose
Paranoid delusions
Hallucinatory phenomena
(ie psychotic features)

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19
Q

What other condition must be ruled out if the patient presents with hypomania?

A

ADHD and ODD or CD

  • Distractability
  • Motor agitation
  • Impulsive angry outbursts
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20
Q

What key information can help distinguish ADHD from Bipolar disorder?

A

Presence of symptoms in preschool favors ADHD

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21
Q

What is one major downside to using the mood stabilizing (ie manic phase) agents recommended for children?

A

The all require blood levels

22
Q

What is a good treatment option for youth with bipolar depression?

A

Lithium

23
Q

What organs need to monitored when patients are put on lithium?

A

Kidney

Thyroid

24
Q

What condition needs to be monitored for patients taking carbamazepine?

A

Agranulocytosis or aplastic anemia

25
Q

What organ system needs to be monitored for patients taking Divalproex?

A

LFTs and Platelets

PCOS in young women

26
Q

What test needs to be ordered on all females before starting them on mood stabilizing agents?

A

Pregnancy test- Teratogenic

27
Q

What is one benefit of using the atypical antipsychotics in females?

A

No teratogenic effects

28
Q

What conditions do patients on atypical antipsychotics need to be monitored for?

A

Metabolic syndrome

  • Weight gain
  • Diabetes
  • Hypercholesterolemia
29
Q

What is another potential side effect of atypicals?

A

Tardive dyskinesia

- Assess baseline using Abnormal Involuntary Movement Scale

30
Q

What are some other options for treating bipolar-depression?

A

SSRI
Bupropion
Lamotrigine
Divalproex

31
Q

What risk become a legitimate possibility when using antidepresants to treat bipolar depression?

A

Unmasking of a manic episode

32
Q

What condition has a high rate of comorbidity with bipolar disorder and could still impact other areas of the patients life?

A

ADHD

33
Q

What type of psychotherapy is usually successful in treating a bipolar patient?

A

Cognitive behavior therapy
- Reduce negative thoughts; Build self-esteem
Family therapy as needed

34
Q

What is cyclothymic disorder?

A

2 year history of fluctuating hypomanic and depressive symptoms
Never meets criteria for hypomania, mania, or major depression
Symptoms are present for at least half the time
Symptoms are never absent for longer then 2 months

35
Q

What is bipolar I?

A

At least one manic episode

36
Q

What is bipolar II?

A

Hypomnic episode & major depressive episode

37
Q

What is a hypomanic episode?

A

Same as manic episode, but shorter in duration and less intense

  • Elevated, expansive, or irritable mood
  • Increased energy/activity
  • 4+ days
  • 3 or less associated symptoms
38
Q

What is a manic episode?

A

Elevated, expansive, or irritable mood
Increased energy/activity
7+ days
3+ associated symptoms

39
Q

What atomatically qualify’s the patient for a manic episode?

A

Requires hospitalization

Psychotic features

40
Q

What is MDD?

A

Depressed mood or anhedoina for 2 weeks

Four or more associated symptoms

41
Q

What are the associated symptoms for MDD?

A 
SI
Fatigue
Impaired concentration
Excessive guilt
Psychomotor retardation/agitation
Hypersomnia/insomnia
Unintentional change in weight/appetite
42
Q

What are considered mixed symptoms?

A

Mood episodes with simultaneous symptoms from opposite poles

43
Q

When will cyclothymia typically present?

A

Adolescence or early adulthood

44
Q

What conditions need to be in the differential when evaluating a patient for bipolar disorder?

A

Substance-induced or another medical condition
Bipolar I and Bipolar II with rapid cycling
Cyclothymia
Borderline personality disorder

45
Q

What substances can induce mania?

A

Stimulants and steroids

46
Q

What medical conditions can cause mania?

A

Hyperthyroidism

Epilepsy

47
Q

What is the treatment for cyclothymic disorder?

A 
Mood stabilizers
- Lithium
- Valproate
Atypical antipsychotics
Lamotrigine- Depressive symptoms
48
Q

What medication should be avoided in patients with cyclothymic disorder?

A

Antidepressants

- May induce (hypo)mania

49
Q

When will patients with cyclothymic disorder seek help?

A

When they have depression

50
Q

When does a loved one bring a cyclothymic patient in to be evaluated?

A

(hypo)manic states

51
Q

Can cyclothymic disorder progress?

A

Yes

52
Q

What are the best treatment options for Bipolar I disorder with mood-congruent psychotic features?

A

Mood stabilizers and Atypical antipsychotics

Case Files Psychiatry (10 decks)

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