Bipolar Disorders Flashcards
Bipolar disorder 1
At least 1 manic episode with either a hypomanic or depressive episode
Mood is destabilized throughout bipolar episodes and requires hospitalization often
Bipolar 2 disorder
At least 1 hypomanic and 1 current or past depressive episode only.
- there is NO history of manic episodes and NO psychosis
Mood is normally stable throughout the episode
- have suicide risk though and use of antidepressants can send them into a manic episode
Manic episode
At least 1 week of abnormally and persistently elevated/irritable mood
At least 3 of the following are present during this as well as a noticeable change from baseline by others:
- grandiose ideology
- decreased need for sleep (usually only needs 3 hrs)
- excessive talking and interrupting
- flight of disease/racing thoughts
- easily distracted
- clang associations (uses words that rhyme together that doesn’t make sense combined)
- increased goal-directed activity (“throws caution to the wind”)
- engages in risky behaviors (pleasure driven)
requires hospitalization due to seriousness of repercussions and is also not attributable to another illness or substances abuse (stimulants)
**also patients tend to not be able to make social connections or hold jobs since there is severe functional impairments **
Cyclothymic disorder
Mild form of bipolar 2 disorder that lasts greater than 2 years and symptoms being present at least half of the time
- has many or few symptoms of hypomanic episodes, but doesn’t long enough to be called bipolar 2
Remission also must last no more than 2 months (if it occurs)
Epidemiology of bipolar 1
2% lifetime prevalence
Age of onset = usually 20-30s (average = 25)
Increased risk of suicide patients (6-7%)
Possess a comorbidity of some sort
Often possess other functional impairments
Often have a comorbid substance abuse issue
Treatment of bipolar 1 mania
First line medication:
- lithium
- quetiapine
- divalproex
Treatment of bipolar 1 depression
First line therapies:
- quetiapine
Bipolar maintenance (euthymic) treatments
First line therapies
- lithium
- quetiapine
- lamotrigine
Difference between manic and hypomanic episodes
Hypomanic is essentially a mild manic episode where the mood disturbance does NOT cause impairment to social or occupational functioning or need to hospitalization
Also hypomanic = no psychotic features and lasts at least 4 consecutive days and needs at least 3 of DIG FAST
What is the most important symptom of a manic episode (most sensitive)?
Decreased need for sleep
- usually sleeps for less than 3-4 hours
Presentation of inital Bipolar 1 episode that gets diagnosed
Usually presents with depression first (54%)
Then mixed or manic episodes (24% and 22%)
dont assume that someone who doesn’t have mania doesnt have bipolar 1 necessarily
** because of this, it is often that bipolar patients tend to get initially diagnosed with MDD first, then later bipolar 1**
How do you ask for bipolar symptoms
Have you ever had a period of days at a time when you:
- haven’t needed to sleep more than an hour or two a night?
- have you done things recently that are really risky?
- have you started a lot of projects recently?
Mnemonic for bipolar symptoms
“DIG FAST”
- Distractability
- Impulsivity
- Grandiosity
- Flight of ideas
- Activity that is goal driven/Agitation
- Sleeplessness (3ish hrs a night max usually)
- Talkativeness or pressured speech (keeps rambling fast and hard to interject)
Why cant you use just an SSRI in depressive episodes for patients with bipolar 1 or family history of bipolar 1 ?
1) it often wont work
2) it often sends them into a manic episode
Lithium
Is the gold standard mood stabilizer for bipolar disorders
Also treats acute manic episodes and prevents relapse
MOA: unknown but believed to be related to inhibition of phosphoinostol cascade
has very narrow therapeutic index and high toxic risk
ADRs:
- tremors
- thyroid abnormalities (hypothyroidism most often)
- polyuria
- nephrogenic diabetes insipiudes
- teratogenic (ebstein anomaly)
Contraindicated = pregnancy and renal failure/disease
difficult to use with thiazides, NSAIDs due to the entire metabolism of lithium being done through the kidneys and PCTs in the kidneys
