Bipolar & Related Disorders Flashcards
In DSM-V, bipolar lies between __________ and ________ disorders.
schizophrenia and depressive disorders
What are mood episodes related to bipolarism?
manic, hypomanic and depression
What are characteristics of major depressive episodes in bipolar?
Sadness or anhedonia plus other sx’s (to total 5) for at least 2 weeks
- Poor concentration
- Poor energy
- Poor self-esteem/guilt
- Suicidality
- Sleep disturbance
- Weight change (>5% in a month) or appetite change
- Psychomotor disturbance
What are characteristics of manic/hypomanic episodes in bipolar?
4 days (hypomanic, no severe impairment) to at least 7 days (manic, severe impairment, hospitalization) of abnormally euphoric, expansive or irritable mood
Increased activity/energy
At least 3 mood elevation symptoms:
- Inflated self-esteem
- Decreased need for sleep
- Over talkativeness
- Flight of ideas
- Distractibility
- Excessive goal-directed activity/psychomotor agitation
- Impulsivity
“Mixed features” within depressive episode of bipolar
At least 3 manic/hypomanic symptoms during majority of days of current/most recent depressive episode
Patient still meets full criteria for manic or hypomanic episode, also the full depressive criteria, and thus still is considered Bipolar I or II (usually II)
Criteria for Bipolar I disorder
- At least 1 manic episode
- Depressive episodes often experienced previously, but not required for diagnosis (mania is very striking)
Criteria for Bipolar II disorder
At least 1 hypomanic and at least 1 major depressive episode, but NO MANIC EPISODE
Criteria for Cyclothymic Disorder
Mood elevation and depressive symptoms for at least 2 years that do not fully meet criteria for episodes for diagnosis of bipolar diseases I or II
- Similar to persistent depression and MDD
PE of bipolar I
- Physical and neuro exam normal
- speech rapid and pressured; skips from one idea to another
Labs when possible bipolar patient to rule out other causes?
CBC and lytes (r/o infection)
Thyroid function
RPR/VDRL (r/o syphilis)
UA tox screen (r/o drug-induced)
Difference between Bipolar I and II?
bipolar I is more extreme and has manic episode; bipolar II NO manic episode
Bipolar I treatment
- Mood stabilizers (lithium, valproate)
- Add benzo or neuroleptic if concurrent agitation or psychosis (e.g. delusions, hallucinations)
- ECT for severe or refractory cases
Bipolar II treatment
First line is mood stabilizers (lithium, valproate)
Antidepressants with caution; can precipitate hypomania or mania
