Bipolar Jeopardy Flashcards
In which BD may pts experience delusions?
Bipolar I
In which BD may sx be present for 4-6 days?
Bipolar II
Which BD may present w/mixed sx?
Bipolar I or II
in DSM-4, only Bipolar I presented as a mixed episode
In which BD is a depressive episode not a diagnostic requirement?
Bipolar I
Pts are typically in depressed state 15x’s more than a (hypo)manic state in bipolar I or II?
Bipolar II
- Bipolar I depressed ~2x’s more than manic
Which BD can easily be mistaken for cyclothymia?
Bipolar II
Pts are more likely to have a hypomanic episode with this type of Bipolar disorder.
Bipolar I
Which BD causes significant impairment in social or occupational function or necessitates psychiatric hospitalization.
Bipolar I
The likelihood of a M or F having this form of BD is essentially equal.
Bipolar I
- Data unclear for bipolar II
This sex is more likely to have a first mood disturbance be a manic episode.
Males
If the 1st mood disturbance is a manic episode, the risk of future mood episodes is this %.
80-90%
What % risk does an identical twin have if his or her sibling is dx’d with BD?
~70%
The average age of onset for Bipolar II is later than Bipolar I’s, which is this age.
- What age for bipolar II?
18 y/o
- Bipolar II: mid-20s
With each ensuing episode, the length of time a pt spends in a manic episode does this.
Increases/lengthens
For someone with a family hx of BD, the risk is lower if the affected relative is on this side of the family.
Paternal side
After the first mood disturbance in MDD, the risk of future depression episodes is this.
- After 2 episodes?
- After 3 episodes?
50%
- After 2 episodes, risk is ~70%;
- After 3 episodes, risk is ~90+% (definitely do maintenance treatment)
For patients with BD, as the total # of mood episodes increases, the inter-episode interval does this.
Shortens/decreases
The average lifetime # of manic episodes a pt will have is 9-10 unless the physician does this .
Gives maintenance medication
Lithium
Divalproex/valproic acid (Depakote)
Olanzapine (Zyprexa)
——————————————-
Generally avoided in tx of bipolar pts with liver disease
Divalproex/valproic acid (Depakote)
Lithium
Divalproex (Depakote)
Olanzapine (Zyprexa)
——————————————-
This medication can be rapidly loaded, and pts who respond improve the most in the first 3 days
Divalproex (Depakote)
Lithium or Divalproex (depakote) monotherapy successfully treats manic episodes to resolution in
1 out of this many patients.
3
- Rule of 1/3’s: 1/3 respond well, 1/3 partial respond, 1/3 respond poorly
Lithium’s response rate in treating bipolar pts w/ euphoric mood, family hx of the illness, and/or few lifetime episodes is this:
70% Good/very good
- Lithium
- Lithium + FGA/SGA
- Divalproex (Depakote)
- ## Divalproex (Depakote) + FGA/SGAThe first choice for treating a severe acute manic episode is this:
Lithium + FGA/SGA or divalproex (depakote) + FGA/SGA
Maintenance treatment should always be recommended after this # of manic episodes?
2
- And usually after 1 episode
For patients with BD, tx w/ this medication appears to decrease the risk of suicide.
Lithium
Lithium
Divalproex (Depakote)
Olanzapine (Zyprexa)
———————————————
This drug is generally avoided in treating bipolar patients with renal disease
Lithium
Lithium
Divalproex (Depakote)
Olanzapine (Zyprexa)
———————————————
Generally avoided in treated bipolar patients who are obese.
Olanzapine (Zyprexa)
The risk of this is lower if lithium is discontinued gradually over months rather abruptly over days.
Affective switch to mania.
Even though this combination medication contains fluoxetine (prozac), it is effective in treating bipolar depression and has no increased risk of a switch to a manic episode.
Olanzapine/fluoxetine (Symbyax)
Since these type of antidepressants were introduced, studies have shown an increased switch rate and an increase in the # of rapid cycling cases.
Tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRI’s)
Use of this tx regimen for pts with bipolar I depression is contraindicated.
Antidepressant monotherapy
Of all the antidepressants, using this one appears to carry the least risk of inducing a manic episode.
Bupropion (Wellbutrin)
Meds that are recommended for treating bipolar depression are lithium, quetiapine (Seroquel), lurasidone (Latuda), and these two meds.
- Lamotrigine (Lamictal)
- Olanzapine/fluoxetine (Symbyax)
While often used as an adjunct treatment of major depression, this SGA is NOT shown to be beneficial in the tx of bipolar depression.
Aripiprazole (Abilify)
When using an antidepressant to treat bipolar depression, this should be done after the episode has remitted.
Discontinue the antidepressant
This medication can be used to treat acute bipolar depression, for maintenance treatment, but NOT for an acute manic episode.
Lamotragine (Lamictal)
Used in the tx of BD, this medication has the narrowest gap between therapeutic and toxic concentration of any drug routinely prescribed in psychiatry.
Lithium
To rapidly load a pt weighing 150 pounds with 20 mg/kg of divalproex (depakote), this amount of the medication is prescribed
1,500mg
The % of pts with BD whose life ends by suicide is this.
- How many times higher is the relative risk vs. the general pop?
- How many times higher than MDD?
~16%
- 20x’s the relative risk of the general population
- About the same relative risk as in MDD
Lithium toxicity that is so severe as to be life threatening; it is treated with this.
Dialysis
Jessie Jackson Jr. appears to claim that these two manic symptoms contributed to his illegal misuse of campaign funds.
- Grandiosity
- Dangerous pleasurable activities
Often this symptom heralds
the onset of a new manic episode.
Decreased need for sleep
Mania then depression or
Depression then mania
This happens 60% of the time.
Mania then depression
Individuals in a manic episode frequently resist efforts to treat them because they do not recognize that they are ill, which is called this.
Anosognosia (or lack of insight)
A laboratory finding that is diagnostic of a manic episode
is this.
None
