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Year 2 Psych exam I > Bipolar, Vertrees > Flashcards

Bipolar, Vertrees Flashcards

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1
Q

definition of bipolar

A

refers to group of disorders in which patient has sustained mood episodes in both directions

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2
Q

types of bipolar disorders

A

bipolar I
bipolar II
cyclothymic
substance/medication induced bipolar

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3
Q

mood disorders are based on what episode types

A

manic, depressed, hypomanic, dysthymic persistence

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4
Q

which bipolar type is equal for genders

A

bipolar I

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5
Q

total bipolar affective disorders occur more in W or M

A

W:M 3:2

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6
Q

median age onset BAD

A

earlier in men

usually around 25 yrs

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7
Q

what is criteria for manic episode

A

presence of abnormally elevated, expansive or irritable mood for at least one week (or less if need hospitalization)
+ 3 Sx (on another flash card)

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8
Q

Sx or characteristics of bipolar disorder

A

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

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9
Q

what will classify episode from anti depressant Tx to be manic

A

if continues past expected physiologic effect

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10
Q

how do manic episodes affect life

A

causes impairment in occupational, social, relationships or results in hospitalization to prevent harm to self or others

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11
Q

clinical findings in mania

A 
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
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12
Q

course of mania

A

onset usually abrupt
last week-months
shorter than depressive episodes
preceded or followed by depression

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13
Q

in the course of mania when is highest risk of suicide

A

subsequent depressive episode

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14
Q

hypomanic episode

A

persistent elevated, expansive or irritable with 3+ manic Sx
Does NOT markedly impair social/occupational functioning
no hospitalization needed, no psychotic features

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15
Q

which type mood episodes have high rate of psychotic eatures

A

peri partum

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16
Q

Bipolar I classification

A

al least 1 manic episode

classified as type of most recent episode: manic, depressed, hypomanic

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17
Q

Bipolar II criteria

A

hypomanic episodes and major depressive episodes
relatives have higher rate in Bipolar II than I
higher rate of comorbidity with substance abuse disorders

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18
Q

cyclothymic disorder

A

chronic fluctuating disturbance between periods of hypomanic Sx and periods of depressive Sx
minimum course 2 years

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19
Q

Tx cyclothymic disorder

A

lithium

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20
Q

cyclothymic disorder patients sensitive to what Tx

A

antidepressant induced hypomania

21
Q

catatonia

A

not moving body, very odd

22
Q

what are mixed features of bipolar disorder

A

manic or hypomanic episode with significant depressive Sx
mood and Sx picture alternates rapidly
significantly elevated suicide risk

23
Q

stimulants that can cause bipolar like disorder

A

amphetamine, PCP, cocaine

antidepressants

24
Q

what exogenous steroida can cause bipolar like disorder

A

HRT, testosterone PEDs

25
Q

what endogenous endocrine disorders present like bipolar

A

hyperthyroidism

pheo

26
Q

neuro presentations like bipolar

A

fronto temporal dementia

27
Q

bipolar fam Hx increases risk for

A

major depressive disorder and bipolar affective disorder

28
Q

bipolar in monozygotic twins

A

70-90%

29
Q

FDA approved mood stabilizers in mania

A

lithium, valproate, carbamazepine

30
Q

which antipsychotic can be monotherapy in bipolar disorder

A

olanzapine

31
Q

mood stabilizers in maintenance of bipolar

A

lamotrigine, adjunctive anti-psychotics

benzos

32
Q

top drug for bipolar BAD II

A

lamotrigine

33
Q

key in Tx plan for bipolar

A

psychoeducation

34
Q

depression episode ends but pyschosis continues

A

schizophrenia

35
Q

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

A

bipolar I, MRE manic with psychosis

36
Q

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

A

place patient on 72 hr mental health hold

call wife

37
Q

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

A

obtain VPA level and LFTs
CBC (CPA cause thrombocytopenia
lipid panel
BMP and TSH

38
Q

man off his valproate also showing elevated LFTs

Tx plan

A

start lithium
start atypical antipsychotic for psychotic Sx
check hepatitis serologies

39
Q

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?

A

bipolar II, MRE depressed, w/psychosis (voices)

40
Q

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?

A

bipolar I MRE manic(lose job/spent money) with psychosis(spent all money in gamble)

41
Q 
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?
A

BMP
CBC
urine drug screen
LFTs

42
Q 
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?
A

BMP
CBC
urine drug screen
LFTs

43
Q

M 2-3 years high and lows
stable employment
each type episode lasts 1-2 weeks

A

cyclothymic

44
Q

Tx for cyclothymic

A

lithium

45
Q

cyclothymic disorder assoc with +FMH for what

A

bipolar I

46
Q

45 F with MDD recurrent
on venlafaxine
has increased energy, talking too much, dec sleep

A

medication induced bipolar disorder

47
Q

important factors to address for non-adherence to meds in bipolar

A

potential side effects
goals and how difficult it is to achieve them
impact on family and friends

48
Q

most effective psychotherpeutic intervention during non-adherence time of illness

A

psychoeducation and family therapy

Year 2 Psych exam I (15 decks)

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