Bipolar Disorders and Mood Stabilizers - Vertrees

Question 1

bipolar

Answer 1

pt has sustained mood episode

both directions

BAD - bipolar affective disorder
MDD - major depressive disorder

Question 2

epidemiology of bipolar

Answer 2

type 1 and 2

more in women
-type 1 - M = F
type 2 - F > M

age of onset 25yo
-men earlier onset

can be quite disabling

Question 3

bipolar 1 vs. 2

Answer 3

2 more prevalent

Question 4

bipolar disorders

Answer 4

type 1 and 2
cyclothymic
substance/med induced

Question 5

episodes

Answer 5

manic
depressed (MDE)
hypomanic
dsthymic persistence

Question 6

50% homeless

Answer 6

has significant mental illness

80% - when add in substance abuse

Question 7

manic episode

Answer 7

elevated, expansive, or irritable mood

at least 1 week - or less if hospitalized

3 of 7 sx:
1 -inflated self esteem and grandiosity
2 -decreased need for sleep**
more talkative or pressured
3 -flight of ideas/racing thought
4 -distractibility - everything stimulates thought
5 -increased goal directed activity
6 -excessive involvement in pleasurable activities

Question 8

decrease in sleep and increase in energy

Answer 8

manic episode

Question 9

distractability

Answer 9

everything stimulates thought and is amazing

Question 10

manic patients

Answer 10

decreased sense of boundaries

-lack of filter

Question 11

manic episode secondary to anti-depressant tx - continues past expected physio effect

Answer 11

still counts as manic episode

Question 12

mania

Answer 12

emotional outpouring
irritable, expansive, euphoria
more energy - taking care ofbusiness
loss of consideration for consequence
grandiosity

Question 13

manic course

Answer 13

abrupt onset
-last week to months

recurrence risk significant
preceded or followed depression

heightened risk of suicide in depressive episode

Question 14

hypomanic

Answer 14

4 days - elevated, expansive, irritable mood

3 or more manic symtpoms

does not impair social/occupational function

no hosp needed
no psychotic features

Question 15

hospitalization for psych

Answer 15

loss of social functioning

Question 16

psychosis

Answer 16

symptom state - in severe manic or depressed episode

Question 17

cotard delusion

Answer 17

delusion that they are already dead

Question 18

hypomania

Answer 18

without psych features

Question 19

peripartum mood episodes

Answer 19

high rate of psychotic features

lots of hormone changes in pregancy

Question 20

bipolar 1

Answer 20

hx of one manic episode

diagnosis specified - what is most recent episode**
-manic, depressed, hypomanic

recurrent episodes mania and depression

Question 21

bipolar 2

Answer 21

hypomanic episode and major depressive episode

not full criteria for manic episode

Question 22

significant fam hx

Answer 22

bipolar 2

Question 23

cyclothymic disorder

Answer 23

chronic, fluctuating disturbance
-between periods of hypomanic sx and periods of some depressive sx

minimum course 2yrs
# episodes not numerous
no mania, hypomania, major depressive episodes

sensitive to AD-induced hypomania

Question 24

tx cyclothymic disorder

Answer 24

60% respond well to lithium

Question 25

cyclothymic fam hx

Answer 25

30% BAD fam hx

Question 26

catatonia

Answer 26

so overwhelmed with emotion

-not moving or can’t stop moving

Question 27

bipolar DDx

Answer 27

stimulant use
exogenous steroids
endogenous endocrine disorder
neurologic - FTD, ICM
other psych disorder

Question 28

bipolar tx

Answer 28

lithium
valproate
carbamazepine

adjunct antipsychotics

benzos - good augmenting agent

Question 29

mood stabilizers in bipolar tx

Answer 29

lamotrigine - good for bipolar type 2

but bad for manic episode

Question 30

psychotic features - continue 2 weeks after depressive/manic episode

Answer 30

schizoaffective

Question 31

valproate

Answer 31

liver effects

liver function test to see if pt can tolerate it

Question 32

therapeutic Lithium

Answer 32

0.5-1.2

Question 33

hypomania

Answer 33

no psychosis

but can be depressed during psychotic episode

Question 34

hypomania vs. mania

Answer 34

hospitalized or psychosis
or loss of function
-mania

Question 35

lots of bipolar pt

Answer 35

have previous major depressive incidents - before hypomania and mania

Question 36

drug abusing co-working physician

Answer 36

have obligation to report

risk for patients

Question 37

DDx for manic like state

Answer 37

stimulants
PCP, meth
thyroid storm
ICM
energy drink
anti-depressant induction

Question 38

tx of cyclothymic

Answer 38

lithium

Question 39

tx of bipolar 1

Answer 39

monotherapy - valproate