Bipolar Related Disorders Flashcards
what is dysthymia?
chronic low level depression
what is cyclothymia?
chronic hypomania (>2 years) -it doesn't cross into mania
what is psychomotor retardation?
depression causes the patient to feel and act slowed down
what is the DSM-V definition of mania?
- distinct, abnormal, elevated (nothing can upset them), expansive (“at one w/ universe) or irritable mood x 7 days minimum
- 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
what is DRTHIGH of mania?
Distractable Talkative Racing thoughts Hyperactive Impulsive Grandiose Hyposomnic
what is hypomania?
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
what is dysthymia?
not fully depressed, but not fully euthymic either (between)
how are most people on the affect range? if manic? if depressed?
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)
what is a mixed episode?
meets criteria for both manic episode and major depressive disorder –> bipolar
what is bipolar 1?
mania + major depressive episode
- MUST have mania, but don’t need to have depression
- but depression has the worst effects
what is bipolar 2?
hypomania + major depressive episode
- MUST have hypomania, but don’t need to have depression
- but depression has the worst effects
what are other characteristics of mania?
- 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)
what is there a greater likelihood of in a bipolar person’s life?
job loss, divorce, and legal issues
do bipolar people spend more time depressed or manic? which is more disabling? more catastrophic?
spends more time depressed
- depressed = disabling
- manic = catastrophic
how long does it take to diagnose bipolar?
~decade, and 4 doctors
how long do bipolar patients spend euthymic? can they recall their previous mania?
6 months
-about half of patients don’t remember or don’t report previous mania
what are biological factors causing bipolar disorder?
- altered neurotransmitter activity (increased DA, SR, NE)
- monoamine receptor deficiency theory (opposite of depression)
- genetics (high association)
- kindling hypothesis
what is the kindling hypothesis in terms of bipolar disease?
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
what is the occurrence of bipolar
1% lifetime prevalence
- women = men in bipolar 1
- women > men in bipolar 2
what are psychosocial factors in bipolar disease?
- 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
should you use antidepressants for bipolar depression?
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
should you use antipsychotics for bipolar?
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
why do you prefer antimanic agents to psychotherapy in bipolar?
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
what are antimanic agents?
- lithium
- divalproex
- carbamazepine
- atypical antipsychotics
what is lithium in terms of bipolar disorder?
antimanic agent
- provides Ca++ membrane stability
- promotes neuronal health and protective factors
- end organ damage to kidneys and thyroid
what is divalproex in terms of bipolar disorder?
antimanic agent
- increases GABA activity/tone
- pancreatic, liver, and platelet damage
what is carbamazepine in terms of bipolar?
anti-epileptic agent that doubles as antimanic agent
-blocks Na+ channels and promotes neuronal health
what are atypical antipsychotics in terms of bipolar?
all block D2 receptors
- increase neuronal health and connectivity
- risperidone, aripiprazole
- olanzapine, asenapine
- quietiapine
