Bipolar Related Disorders

Question 1

what is dysthymia?

Answer 1

chronic low level depression

Question 2

what is cyclothymia?

Answer 2

chronic hypomania (>2 years)
-it doesn't cross into mania

Question 3

what is psychomotor retardation?

Answer 3

depression causes the patient to feel and act slowed down

Question 4

what is the DSM-V definition of mania?

Answer 4

1. distinct, abnormal, elevated (nothing can upset them), expansive (“at one w/ universe) or irritable mood x 7 days minimum
2. at least 3 symptoms present for at least 7 days
   - increased self-esteem/grandoisity
   - decreased sleep (need less)
   - increased speech
   - racing thoughts
   - distractibility
   - increased activity (energy is key for DSM5) –> must cause distress/dysfunction
   - increased dangerous impulsivity

Question 5

what is DRTHIGH of mania?

Answer 5

Distractable
Talkative
Racing thoughts
Hyperactive
Impulsive
Grandiose
Hyposomnic

Question 6

what is hypomania?

Answer 6

milder mania of at least 4 days

• same symptoms as mania
• provide unequivocal change in function, personality clearly noted by others
• not severe enough to cause marked impairment

Question 7

what is dysthymia?

Answer 7

not fully depressed, but not fully euthymic either (between)

Question 8

how are most people on the affect range? if manic? if depressed?

Answer 8

usually fluctuate in euthymia, higher or lower

if manic, do not become sad (fluctuate at top)
if depressed, don’t become happy (fluctuate at bottom)

Question 9

what is a mixed episode?

Answer 9

meets criteria for both manic episode and major depressive disorder –> bipolar

Question 10

what is bipolar 1?

Answer 10

mania + major depressive episode

• MUST have mania, but don’t need to have depression
• but depression has the worst effects

Question 11

what is bipolar 2?

Answer 11

hypomania + major depressive episode

• MUST have hypomania, but don’t need to have depression
• but depression has the worst effects

Question 12

what are other characteristics of mania?

Answer 12

• increased sexual activity
• increased seductive, flashy dress with more accessorizing (soft sign)
• increased anger/escalation
• increased energy, able to work more, be more creative, think outside the box, take chances
• can become psychotic (delusions, hallucinations, thought disorder –> may look schizophrenic)

Question 13

what is there a greater likelihood of in a bipolar person’s life?

Answer 13

job loss, divorce, and legal issues

Question 14

do bipolar people spend more time depressed or manic? which is more disabling? more catastrophic?

Answer 14

spends more time depressed

• depressed = disabling
• manic = catastrophic

Question 15

how long does it take to diagnose bipolar?

Answer 15

~decade, and 4 doctors

Question 16

how long do bipolar patients spend euthymic? can they recall their previous mania?

Answer 16

6 months

-about half of patients don’t remember or don’t report previous mania

Question 17

what are biological factors causing bipolar disorder?

Answer 17

• altered neurotransmitter activity (increased DA, SR, NE)
• monoamine receptor deficiency theory (opposite of depression)
• genetics (high association)
• kindling hypothesis

Question 18

what is the kindling hypothesis in terms of bipolar disease?

Answer 18

begins as bipolar disease 2, then progresses to 1, then gets worse

• too much neuronal firing in limbic system
• seizure and anti-epilepsy drug model via Na+ channel blockade

Question 19

what is the occurrence of bipolar

Answer 19

1% lifetime prevalence

• women = men in bipolar 1
• women > men in bipolar 2

Question 20

what are psychosocial factors in bipolar disease?

Answer 20

• low self-esteem
• negative outlook
• learned helplessness
• catastrophic los
• demeaning parents
• peers can yield denial and fantasy defenses to occur = mania
• stress can increase mania
• -lowers compliance, disrupts sleep and circadian rhythm, increases substance abuse

Question 21

should you use antidepressants for bipolar depression?

Answer 21

no, b/c they would increase multiple monoamine neurotransmitters

• instead, use lower doses of SSRI
• if you do use antidepressants, must use mood stabilizer first, to prevent increased mania and instability

Question 22

should you use antipsychotics for bipolar?

Answer 22

some atypical (SG) initially approved for schizophrenia

• block D2 receptor (treats and prevents mania)
• block 5HT2a receptors to treat depression (and decrease EPS rates)
• uniquely suited to treat both sides of bipolarity
• -keeps mania down, keeps depression up

Question 23

why do you prefer antimanic agents to psychotherapy in bipolar?

Answer 23

psychotherapy doesn’t work for MANIA, so must use anti-manic (mood stabilizers)
-but many forms and styles may work for the DEPRESSION; during maintenance phase, education is key

Question 24

what are antimanic agents?

Answer 24

• lithium
• divalproex
• carbamazepine
• atypical antipsychotics

Question 25

what is lithium in terms of bipolar disorder?

Answer 25

antimanic agent

• provides Ca++ membrane stability
• promotes neuronal health and protective factors
• end organ damage to kidneys and thyroid

Question 26

what is divalproex in terms of bipolar disorder?

Answer 26

antimanic agent

• increases GABA activity/tone
• pancreatic, liver, and platelet damage

Question 27

what is carbamazepine in terms of bipolar?

Answer 27

anti-epileptic agent that doubles as antimanic agent

-blocks Na+ channels and promotes neuronal health

Question 28

what are atypical antipsychotics in terms of bipolar?

Answer 28

all block D2 receptors

• increase neuronal health and connectivity
• risperidone, aripiprazole
• olanzapine, asenapine
• quietiapine