Bipolar Disorders

Question 1

Estimated Lifetime Prevalence of BPD

Answer 1

-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

Question 2

Risk Factors of BPD

Answer 2

• 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

Question 3

Mood Episodes

Answer 3

-Changes in mood with associated symptoms.

There are manic, hypomanic, missed, and depresses mood episodes

Question 4

Key Feature for BPD diagnosis

Answer 4

-Key feature for a diagnosis of BPD is at least 1 episode meeting criteria for manic, hypomanic or mixed.

Question 5

Criteria for diagnosing BPD

Answer 5

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

Question 6

Associated Symptoms for diagnosing Manic Episode of BPD (DIGFAST)

Answer 6

D=distracted,
I= Impulsive, 
G=Grandiose, 
F=Flight of ideas, 
A=Activities, 
S=Sleep (decreased), T=Talkative

Question 7

Diagnostic criteria for a Hypo Manic Episode

Answer 7

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

Question 8

BPDI

Answer 8

-At least one prior episode of mania

Question 9

BPDII

Answer 9

• no manic
• hypomanic
• at least one episode of MDD

Question 10

Cyclothymic d/o

Answer 10

• no mania
• no mixed
• SOME hypomania s/s
• SOME depression s/s

*not enough s/s to meet the diagnostic criteria

Question 11

“With Mixed Features” episode specifier

Answer 11

• mania with s/s of depression

- depression with s/s of mania

Question 12

Rapid Cycling

Answer 12

at least 4 episodes per year.

*associated with worse prognosis

Question 13

What phase do most spend their time in?

Answer 13

depressive episodes

Question 14

Neurobiology of Bipolar d/o

Answer 14

• White matter connectivity abnormalities
• Increased Volume in the striatum and amygdala
• ↓prefrontal activation @ ventral and medial lateral prefrontal regions
• ↑ amygdala activation

Question 15

Genetic Findings of BPD

Answer 15

• Highly Heritable

- Twin studies show up to 80% of the risk for BPD is inherited

Question 16

BPD Treatment

Answer 16

• determine the mood phase before initiating treatment
• 2 phases: Acute and Chronic
• education
• medication
• therapy
• other

Question 17

Beneficial Meds for Acute Mania

Answer 17

• 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

Question 18

Beneficial meds for Acute mania that also can cause a lot of harm

Answer 18

clozapine, oxcarbazepine

Question 19

Meds for Acute Mania that are unlikely to help

Answer 19

gabapentin, lamotrigine, topiramate, antidepressant monotherapy

Question 20

Meds that are beneficial for mixed manic episodes

Answer 20

• valproate,
• carbamazepine,
• aripiprazole,
• olanzapine,
• risperidone,
• ziprasidone.

**NOTE lithium does not work as well.

** Quetiapine was dropped from the manic episode list

Question 21

Meds for mixed manic episodes that are beneficial but also cause harm

Answer 21

clozapine, oxcarbazepine, quetiapine, Li

Question 22

Meds for mixed manic episodes that are unlikely to help

Answer 22

gabapentin, lamotrigine, topiramate

Question 23

Meds for Bipolar Depression that are likely to benefit

Answer 23

Li, lamictal, Seroquel,

*combination therapy of li+ lituda

Question 24

Meds that are not likely to help in Bipolar Depression

Answer 24

SSRI/SNRI monotherapy, Gabapentin, Aripiprazole

Question 25

Beneficial Maintenance Meds for BPD

Answer 25

• Li,
• Lamotrigine,
• Olanzapine,
• Quetiapine +Li or valproate, -Olanzapine + Li or valproate

Question 26

Maintenance meds of BPD where the harm may outweigh the benefit

Answer 26

Valproate, carbamazepine, aripiprazole

Question 27

Meds that are not likely to help in maintenance of BPD

Answer 27

antidepressant mono therapy

Question 28

Use of SSRI’s in BPD

Answer 28

-can be used as first line treatment WITH a mood stabilizer for acute depression. ** be sure to taper off the antidepressant

Question 29

Use of tricyclics in BPD

Answer 29

-AVOID THEM

**associated with increased risk of manic switch

Question 30

Use of antidepressants in BPD

Answer 30

antidepressants should not be used to treat a current mixed episode or in patients with a history of rapid cycling

Question 31

2nd Generation Anti-Psychotics

Answer 31

• quetiapine
• risperidone
• olanzapine
• ziprasidone
• asenapine
• lurasidone

Question 32

Goals of Interpersonal and Social Rhythm Therapy

Answer 32

Resolve issues associated with grief/role transition/role dispute and interpersonal deficits

Strategies to enhance social and circadian rhythm regularity

Question 33

Goals of Family Focused Therapy

Answer 33

Stabilize and prevent recurrence

Always involves family/support system