Bipolar, Vertrees Flashcards
definition of bipolar
refers to group of disorders in which patient has sustained mood episodes in both directions
types of bipolar disorders
bipolar I
bipolar II
cyclothymic
substance/medication induced bipolar
mood disorders are based on what episode types
manic, depressed, hypomanic, dysthymic persistence
which bipolar type is equal for genders
bipolar I
total bipolar affective disorders occur more in W or M
W:M 3:2
median age onset BAD
earlier in men
usually around 25 yrs
what is criteria for manic episode
presence of abnormally elevated, expansive or irritable mood for at least one week (or less if need hospitalization)
+ 3 Sx (on another flash card)
Sx or characteristics of bipolar disorder
inflated self esteem or grandiosity
decreased need for sleep
more talkative or pressured
flight o ideas/subjective racing thoughts
distractibility
increased goal directed activity
excessive involvement in pleasurable activities
what will classify episode from anti depressant Tx to be manic
if continues past expected physiologic effect
how do manic episodes affect life
causes impairment in occupational, social, relationships or results in hospitalization to prevent harm to self or others
clinical findings in mania
mood is either irritable, expansive or euphoric a lot of emotional outpouring pressured, trangential speech more energy distractible loss of consideration for consequences faster thoughts, flighty ideas fundamental truths become all encompassing gradiosity
course of mania
onset usually abrupt
last week-months
shorter than depressive episodes
preceded or followed by depression
in the course of mania when is highest risk of suicide
subsequent depressive episode
hypomanic episode
persistent elevated, expansive or irritable with 3+ manic Sx
Does NOT markedly impair social/occupational functioning
no hospitalization needed, no psychotic features
which type mood episodes have high rate of psychotic eatures
peri partum
Bipolar I classification
al least 1 manic episode
classified as type of most recent episode: manic, depressed, hypomanic
Bipolar II criteria
hypomanic episodes and major depressive episodes
relatives have higher rate in Bipolar II than I
higher rate of comorbidity with substance abuse disorders
cyclothymic disorder
chronic fluctuating disturbance between periods of hypomanic Sx and periods of depressive Sx
minimum course 2 years
Tx cyclothymic disorder
lithium
cyclothymic disorder patients sensitive to what Tx
antidepressant induced hypomania
catatonia
not moving body, very odd
what are mixed features of bipolar disorder
manic or hypomanic episode with significant depressive Sx
mood and Sx picture alternates rapidly
significantly elevated suicide risk
stimulants that can cause bipolar like disorder
amphetamine, PCP, cocaine
antidepressants
what exogenous steroida can cause bipolar like disorder
HRT, testosterone PEDs
what endogenous endocrine disorders present like bipolar
hyperthyroidism
pheo
neuro presentations like bipolar
fronto temporal dementia
bipolar fam Hx increases risk for
major depressive disorder and bipolar affective disorder
bipolar in monozygotic twins
70-90%
FDA approved mood stabilizers in mania
lithium, valproate, carbamazepine
which antipsychotic can be monotherapy in bipolar disorder
olanzapine
mood stabilizers in maintenance of bipolar
lamotrigine, adjunctive anti-psychotics
benzos
top drug for bipolar BAD II
lamotrigine
key in Tx plan for bipolar
psychoeducation
depression episode ends but pyschosis continues
schizophrenia
male with incident at work took LOA
began to feel better than ever, colors have new meanings and he is beyond sleep
having true understanding of god and suspected wife poisoning him
Dx
bipolar I, MRE manic with psychosis
male with incident at work took LOA
began to feel better than ever, colors have new meanings and he is beyond sleep
having true understanding of god and suspected wife poisoning him
wants to kills security gueard
place patient on 72 hr mental health hold
call wife
male with incident at work took LOA
began to feel better than ever, colors have new meanings and he is beyond sleep
having true understanding of god and suspected wife poisoning him
Hx from wife: 2 hosp for bipolar managed by valproate and she thinks hes off meds
obtain VPA level and LFTs
CBC (CPA cause thrombocytopenia
lipid panel
BMP and TSH
man off his valproate also showing elevated LFTs
Tx plan
start lithium
start atypical antipsychotic for psychotic Sx
check hepatitis serologies
34 y.o F politician withdrawn, sleeps 12 hrs, poor appetite and can’t keep up, LOA work
blunted, latent in speech and hears voices
had 2 prev depressive episodes no psychotic
has periods high energy and works excessively little sleep, mother BAD I
Dx?
bipolar II, MRE depressed, w/psychosis (voices)
34 y.o F politician withdrawn, sleeps 12 hrs, poor appetite and can’t keep up, LOA work
blunted, latent in speech and hears voices
had 2 prev depressive episodes no psychotic
has periods high energy and works excessively little sleep,
admit and start on lithium SSRI and risperidone and elevated suicide precautions
comes back 6 mo later, fight at work, maxed out credit cards, no sleep , singing
Dx now?
bipolar I MRE manic(lose job/spent money) with psychosis(spent all money in gamble)
M surgeon who took baseball bat to car in his spot pressure hyperverbal and very labile agressive and gradiosity new picking at own skin labs to order?
BMP
CBC
urine drug screen
LFTs
M surgeon who took baseball bat to car in his spot pressure hyperverbal and very labile agressive and gradiosity new picking at own skin labs to order?
BMP
CBC
urine drug screen
LFTs
M 2-3 years high and lows
stable employment
each type episode lasts 1-2 weeks
cyclothymic
Tx for cyclothymic
lithium
cyclothymic disorder assoc with +FMH for what
bipolar I
45 F with MDD recurrent
on venlafaxine
has increased energy, talking too much, dec sleep
medication induced bipolar disorder
important factors to address for non-adherence to meds in bipolar
potential side effects
goals and how difficult it is to achieve them
impact on family and friends
most effective psychotherpeutic intervention during non-adherence time of illness
psychoeducation and family therapy
