Chapter 4 Pt 3 Flashcards
what is the DSM V criteria for bipolar I
occurrence of a MANIC EPISODE
can include major depression (but not required for diagnosis)
what is the prevalence and mean onset of bipolar 1
1-2% and
usually before 30- mean age of first mood episode is 18
what mood disorder should always be include in differential of psychotic patient
bipolar I (cannot be bipolar II if psychotic features present)
what are the genetics of bipolar I
1st degree relatives 10x likely to develop illness
monozygotic twin concordance 40-70%
dizygotic twin concordance 5-25
what has the highest genetic link of all major psychiatric disorders
BIPOLAR I
what is rapid cycling
occurrence of 4 or more mood episodes in 1 year (major depressive, hypomanic, or manic)
untreated manic episodes generally last how long
months
90% of people after one manic episode will have a repeat episode when
within 5 years
the course is usually chronic with relapses
as disease progresses, episodes may occur more frequently
what helps decrease risk of relapse in bipolar I
maintenance treatment with mood stabilizing medications b/w episodes
what is the suicide correlation with bipolar
25-50% of people with bipolar attempt suicide
10-15% die by suicide
whale the side effects of lithium
weight gain tremor GI fatigue cardiac arrhythmias seizures goiter/hypothyroidism leukocytosis coma (in toxic doses) polyuria (nephrogenic diabetes insipidus) polydipsia alopecia metallic taste
what mood stabilizer reduces risk of suicide
lithium
what drugs are good for rapid cycling bipolar and that with mixed features
carbamazepine
valproic acid
what is the role of ECT in bipolar patients
works well in treatment of manic episodes
more treatments than depression (up to TWENTY)
especially effective for REFRACTORY or LIFE THREATENING acute mania or depression
what is best treatment for a pregnant women who is having a manic episode
ECT
good alternative to antipsychotics and can be used relatively safely in all trimesters
what is gold standard treatment for bipolar
lithium (reduction of suicide)
a patient with history of postpartum mania has high risk of what and what should be done about it
relapse with future deliveries
should be treated with mood stabilizing agents as prophylaxis
what is the DSM V criteria for Bipolar II
history of one or more major depressive episodes and at least one HYPOMANIC episode
(if there is full manic episode, even in past, it is bipolar I)
what has better prognosis bipolar I or II
bipolar II likely
what is bipolar with anxious distress
feeling keyed up/tense restless difficulty concentrating fears of something bad happening feelings of loss of control
what is bipolar with mixed features
depressive symptoms present during the majority of days during mania/hypomania
dysphoria/depressed mood, anhedonia, psychmotor retardation, fatigue/ loss of energy, feeling worthlessness or inappropriate guilt, thoughts of death or suicidal ideation
what is bipolar with melancholic features
(during depressed episode) characterized by ANHEDONIA early morning awakenings depression worse in the mornings psychomotor disturbances excessive guilt anorexia
what is bipolar with atypical features
(during depressed episode) characterized by
hypersomnia
hyperphagia
reactive mood
leaden paralysis
hypersensitivity to interpersonal rejection
what is bipolar with permpartum onset
hypomanic or manic symptoms occurring during pregnancy or 4 weeks following delivery
