Bipolar Disorders Flashcards
Estimated Lifetime Prevalence of BPD
-1-2%
- 1% for BPI
- 1.1% for BPII
- 2.4% sub threshold BPD (2 core features of hypomania but don’t meet BPD criteria
Risk Factors of BPD
- FH (if a 1st deg. relative has BPD there is a 7-10x higher risk)
- Pregnancy complications/seasons of birth
- stressful life events
- Traumatic Brain Injury
- Multiple Sclerosis
Mood Episodes
-Changes in mood with associated symptoms.
There are manic, hypomanic, missed, and depresses mood episodes
Key Feature for BPD diagnosis
-Key feature for a diagnosis of BPD is at least 1 episode meeting criteria for manic, hypomanic or mixed.
Criteria for diagnosing BPD
1) (distinct period of Abnormally elevated or irritable mood AND persistently increased goal directed activity) OR Energy for 1 week most of the day, everyday
2) 3 or more associated s/s if they are in an elevated mood state, 4 or more associated symptoms if they are in a irritable mood state
Associated Symptoms for diagnosing Manic Episode of BPD (DIGFAST)
D=distracted, I= Impulsive, G=Grandiose, F=Flight of ideas, A=Activities, S=Sleep (decreased), T=Talkative
Diagnostic criteria for a Hypo Manic Episode
1) distinct period of elevated or irritable mood AND increased energy for about 4 DAYS
- not severe enough to cause marked impairment or hospitalization
- changes must be observed by others
BPDI
-At least one prior episode of mania
BPDII
- no manic
- hypomanic
- at least one episode of MDD
Cyclothymic d/o
- no mania
- no mixed
- SOME hypomania s/s
- SOME depression s/s
*not enough s/s to meet the diagnostic criteria
“With Mixed Features” episode specifier
- mania with s/s of depression
- depression with s/s of mania
Rapid Cycling
at least 4 episodes per year.
*associated with worse prognosis
What phase do most spend their time in?
depressive episodes
Neurobiology of Bipolar d/o
- White matter connectivity abnormalities
- Increased Volume in the striatum and amygdala
- ↓prefrontal activation @ ventral and medial lateral prefrontal regions
- ↑ amygdala activation
Genetic Findings of BPD
- Highly Heritable
- Twin studies show up to 80% of the risk for BPD is inherited
BPD Treatment
- determine the mood phase before initiating treatment
- 2 phases: Acute and Chronic
- education
- medication
- therapy
- other
Beneficial Meds for Acute Mania
- Lithium,
- valproate,
- carbamazepine,
- aripiprazole,
- olanzapine
- quetiapine,
- risperidone,
- ziprasidone,
- asenapine,
- paliperidone ER
**combination therapy of lithium or valproate with another one of these could be beneficial
Beneficial meds for Acute mania that also can cause a lot of harm
clozapine, oxcarbazepine
Meds for Acute Mania that are unlikely to help
gabapentin, lamotrigine, topiramate, antidepressant monotherapy
Meds that are beneficial for mixed manic episodes
- valproate,
- carbamazepine,
- aripiprazole,
- olanzapine,
- risperidone,
- ziprasidone.
**NOTE lithium does not work as well.
** Quetiapine was dropped from the manic episode list
Meds for mixed manic episodes that are beneficial but also cause harm
clozapine, oxcarbazepine, quetiapine, Li
Meds for mixed manic episodes that are unlikely to help
gabapentin, lamotrigine, topiramate
Meds for Bipolar Depression that are likely to benefit
Li, lamictal, Seroquel,
*combination therapy of li+ lituda
Meds that are not likely to help in Bipolar Depression
SSRI/SNRI monotherapy, Gabapentin, Aripiprazole
Beneficial Maintenance Meds for BPD
- Li,
- Lamotrigine,
- Olanzapine,
- Quetiapine +Li or valproate, -Olanzapine + Li or valproate
Maintenance meds of BPD where the harm may outweigh the benefit
Valproate, carbamazepine, aripiprazole
Meds that are not likely to help in maintenance of BPD
antidepressant mono therapy
Use of SSRI’s in BPD
-can be used as first line treatment WITH a mood stabilizer for acute depression. ** be sure to taper off the antidepressant
Use of tricyclics in BPD
-AVOID THEM
**associated with increased risk of manic switch
Use of antidepressants in BPD
antidepressants should not be used to treat a current mixed episode or in patients with a history of rapid cycling
2nd Generation Anti-Psychotics
- quetiapine
- risperidone
- olanzapine
- ziprasidone
- asenapine
- lurasidone
Goals of Interpersonal and Social Rhythm Therapy
Resolve issues associated with grief/role transition/role dispute and interpersonal deficits
Strategies to enhance social and circadian rhythm regularity
Goals of Family Focused Therapy
Stabilize and prevent recurrence
Always involves family/support system
