Bipolar & Related Disorders

Question 1

In DSM-V, bipolar lies between __________ and ________ disorders.

Answer 1

schizophrenia and depressive disorders

Question 2

What are mood episodes related to bipolarism?

Answer 2

manic, hypomanic and depression

Question 3

What are characteristics of major depressive episodes in bipolar?

Answer 3

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

Question 4

What are characteristics of manic/hypomanic episodes in bipolar?

Answer 4

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

Question 5

“Mixed features” within depressive episode of bipolar

Answer 5

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)

Question 6

Criteria for Bipolar I disorder

Answer 6

• At least 1 manic episode

- Depressive episodes often experienced previously, but not required for diagnosis (mania is very striking)

Question 7

Criteria for Bipolar II disorder

Answer 7

At least 1 hypomanic and at least 1 major depressive episode, but NO MANIC EPISODE

Question 8

Criteria for Cyclothymic Disorder

Answer 8

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

Question 9

PE of bipolar I

Answer 9

• Physical and neuro exam normal

- speech rapid and pressured; skips from one idea to another

Question 10

Labs when possible bipolar patient to rule out other causes?

Answer 10

CBC and lytes (r/o infection)
Thyroid function
RPR/VDRL (r/o syphilis)
UA tox screen (r/o drug-induced)

Question 11

Difference between Bipolar I and II?

Answer 11

bipolar I is more extreme and has manic episode; bipolar II NO manic episode

Question 12

Bipolar I treatment

Answer 12

• Mood stabilizers (lithium, valproate)
• Add benzo or neuroleptic if concurrent agitation or psychosis (e.g. delusions, hallucinations)
• ECT for severe or refractory cases

Question 13

Bipolar II treatment

Answer 13

First line is mood stabilizers (lithium, valproate)

Antidepressants with caution; can precipitate hypomania or mania