Bipolar I Flashcards
Is there a genetic predisposition for bipolar I disorder?
Yes.
What is the typical onset of bipolar I disorder?
15-30 years old.
What are the diagnostic features of bipolar I?
The occurrence of one manic or mixed episode. Between manic episodes, there may be euthymia. MDD, or hypomania, but none of these are required for the diagnosis.
Are there any gender disparities in the incidence of BD I?
No. Men and women are equally affected.
What is the lifetime prevalence of BD I?
1%
What is the mortality rate in BD?
10-15% mortality by suicide.
What are the characteristics of a manic episode?
A period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and at least 3 of the following: Distractibility, insomnia, grandiosity, flight of ideas or racing thought, agitation, or increase in goal-directed activist socially and etc. thoughtlessness-excessive involvement in pleasurable activities without thinking of risks.
What distinguishes mania from hypomania?
Duration and severity.
- Mania: abnormal mood for at least one week unless hospitalized, symptoms sever enough to impair social/occupational functioning or presence of psychotic symptoms.
- Hypomania: abnormal mood for at least 4 days: symptoms do not significantly impair ability to function.
What is the typical course of a manic episode?
Mania develops over days and lasts about 3 months If untreated. More than 90% of patients will have a recurrence of their manic symptoms. Episodes may occur more frequently as the disease progresses.
What is meant by “rapid-cycling” BD?
4 or more mood disturbances (MDD, mania, mixed) in 1 year.
What is a bipolar mixed episode (aka mixed mania or “dysphoric mania”)?
Criteria are met for both mania and major depression nearly every day during at least a 1-week period. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms. Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thought, restlessness, and suicidal ideation.
What are some common medical causes of manic symptoms?
Endocrine (hyperthyroidism), neurologic (seizures, stroke), and systemic disorders (HIV, vitamin B-12 deficiency)
What are some know precipitants of manic episodes?
Changes in sleep wake cycle, antidepressant treatment, stressful life events, and the postpartum period.
What medication is thought to be the most effective in treating rapid-cycling BD?
There is some evidence that valproate (Depakote) may be most effective.
What is the differential diagnosis for BD?
Other mood disorders, psychotic disorders with mood symptoms, mood disorder due to a general medical condition, and substance-induced mood disorder.
What medications/drugs tend to produce manic symptoms?
Stimulants (methylphenidate), steroids, sympathomimetics, and antidepressants. Recreational drugs include; cocaine, amphetamines, and alcohol. Withdrawal from alcohol or other CNS depressants such as, barbiturates and benzodiazepines can produce manic symptoms.
What medications are used to treat mania?
Lithium, anticonvulsants or carbamazepine, and antipsychotics. Benzodiazepines can be used adjunctively in acute mania for sedation. In severe cases, more than one medication (eg. Lithium combined with atypical antipsychotic and a benzodiazepine) may be used.
What are the medications commonly used to treat the depressive phase of BD I?
Lithium, Symbax (combination of olanzapine and fluoxetine), quetiapine (seroquel), and lamotrigine (Lamictal). Given their potential to induce mania, antidepressants should be used with caution.
What medications are most often used to prevent recurrence of mood episodes (ie. maintenance therapy)?
Lithium, valproate (Depakote), atypical antipsychotics (eg. Aripiprazole (abilify) or olanzapine (zyprexa), and lamotrigine (Lamictal).
What nonpharmacologic treatment can be used for acute mania?
ECT
What adjunct therapies can be useful for patients with BD?
Supportive psychotherapy, family therapy, and group therapy.
