Bipolar ID Flashcards
Bipolar I
Epi
- Lifetime prev: 1-2%
- M=W
- No ethnic differences
- Onset usually <30y
- Highest genetic link of any major psych d/o
- 10-15% commit suicide
Bipolar I
Criteria
Requires manic episode only
depression not required for dx but may occur between manic episodes
Bipolar I
DDx
MDD
Bipolar II
Might have psychotic features
Bipolar I
Course
Chronic with abrupt onset of manic relapses
Untreated mania lasts days to months (must be at least 1 week)
Bipolar II
Criteria
1 or more MDD episodes + at least one hypomanic episode
Bipolar II
Course
- Chronic
- Hypomanic episode at least 4 days
Better prognosis than bipolar I
Bipolar II
DDx
If there has ever been a full manic episode, it is bipolar I
- ADHD
- Borderline personality d/o
- Anxiety disorders
Cyclothymic
Epi
- Lifetime prev <1%
- M=F
- May coexist with borderline personality d/o
- Onset usually 15-25y
Cyclothymic
Criteria
Alternating hypomania and mild/moderate depressive symptoms
Cyclothymic
DDX
If ever there is a full MDD episode, it is bipolar II
Cyclothymic
Course
- Chronic, Criteria = at least 2 years and never symptom free for >2 months
- Approx 1/3 develop bipolar I/II
Bipolar TX
Mood stabilizing medications decrease risk of relapse
- Lithium
- Carbamazepine or valproic acid
- Atypical antipsychotics
- Psychotherapy
- ECT (safe in pregnancy)
- *Avoid antidepressants**
Bipolar TX
Mood stabilizing medications decrease risk of relapse
- Lithium
- Carbamazepine or valproic acid
- Atypical antipsychotics
- Psychotherapy
- ECT (safe in pregnancy)
- *Avoid antidepressants**
Bipolar II
Epi
- Lifetime prev unknown
- Slightly ↑ in women
- Onset usually <30y
- No ethnic differences
Substance/ medication induced bipolar
Epi
Associated with PCP, steroids, bath salts, psychotropic medications
No prevalence data
Substance/ medication induced bipolar
Criteria
Multiple manic sx with or without depressive symptoms that occur after substance intox/withdrawal or medication (but not simply the usual side effects)
Substance/ medication induced bipolar
DDX
If symptoms preceded substance use or last more than a month after cessation, consider bipolar d/o
Substance-related delerium
Substance/ medication induced bipolar
Course
Short lived if substance/medication is stopped
Substance/ medication induced bipolar
Tx
Stop the substance/medication
Other bipolar related d/o
Criteria
Symptoms characteristic of the above disorders that cause significant clinical distress/impairment but do not meet DSM criteria of the above
Other bipolar related d/o
DDX
Diagnosis of exclusion or insufficient evidence to make one of the above diagnosis (i.e. emergency room setting)
Other bipolar related d/o
Course
May be shorter duration of episode (2-3 days) or cyclothymia (<24 months) vs. insufficient symptoms
Mania vs Hypomania
- Mania at least 1 week
- Hypomania 4 days
- Mania may include psychotic symptoms, hypomania does not
Manic s/s
DIG FEAST
- Distractibility
- Insomnia/Irritable
- Grandiosity
- Flight of ideas
- Euphoric mood
- Agitation/goal-directed Activity
- Speedy thoughts
- Thoughtlessness/poor judgement
Co-occurring w/ bipolar
- *Anxiety Disorder
- *Substance Use
- ADHD
- eating disorder (bip II)
MED:
- metabolic syndrome
- migraine
