Bipolar Disorders and Mood Stabilizers - Vertrees Flashcards
bipolar
pt has sustained mood episode
both directions
BAD - bipolar affective disorder
MDD - major depressive disorder
epidemiology of bipolar
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
bipolar 1 vs. 2
2 more prevalent
bipolar disorders
type 1 and 2
cyclothymic
substance/med induced
episodes
manic
depressed (MDE)
hypomanic
dsthymic persistence
50% homeless
has significant mental illness
80% - when add in substance abuse
manic episode
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
decrease in sleep and increase in energy
manic episode
distractability
everything stimulates thought and is amazing
manic patients
decreased sense of boundaries
-lack of filter
manic episode secondary to anti-depressant tx - continues past expected physio effect
still counts as manic episode
mania
emotional outpouring irritable, expansive, euphoria more energy - taking care ofbusiness loss of consideration for consequence grandiosity
manic course
abrupt onset
-last week to months
recurrence risk significant
preceded or followed depression
heightened risk of suicide in depressive episode
hypomanic
4 days - elevated, expansive, irritable mood
3 or more manic symtpoms
does not impair social/occupational function
no hosp needed
no psychotic features
hospitalization for psych
loss of social functioning
psychosis
symptom state - in severe manic or depressed episode
cotard delusion
delusion that they are already dead
hypomania
without psych features
peripartum mood episodes
high rate of psychotic features
lots of hormone changes in pregancy
bipolar 1
hx of one manic episode
diagnosis specified - what is most recent episode**
-manic, depressed, hypomanic
recurrent episodes mania and depression
bipolar 2
hypomanic episode and major depressive episode
not full criteria for manic episode
significant fam hx
bipolar 2
cyclothymic disorder
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
tx cyclothymic disorder
60% respond well to lithium
cyclothymic fam hx
30% BAD fam hx
catatonia
so overwhelmed with emotion
-not moving or can’t stop moving
bipolar DDx
stimulant use exogenous steroids endogenous endocrine disorder neurologic - FTD, ICM other psych disorder
bipolar tx
lithium
valproate
carbamazepine
adjunct antipsychotics
benzos - good augmenting agent
mood stabilizers in bipolar tx
lamotrigine - good for bipolar type 2
but bad for manic episode
psychotic features - continue 2 weeks after depressive/manic episode
schizoaffective
valproate
liver effects
liver function test to see if pt can tolerate it
therapeutic Lithium
0.5-1.2
hypomania
no psychosis
but can be depressed during psychotic episode
hypomania vs. mania
hospitalized or psychosis
or loss of function
-mania
lots of bipolar pt
have previous major depressive incidents - before hypomania and mania
drug abusing co-working physician
have obligation to report
risk for patients
DDx for manic like state
stimulants PCP, meth thyroid storm ICM energy drink anti-depressant induction
tx of cyclothymic
lithium
tx of bipolar 1
monotherapy - valproate
