Chapter 4 Pt 3

Question 1

what is the DSM V criteria for bipolar I

Answer 1

occurrence of a MANIC EPISODE

can include major depression (but not required for diagnosis)

Question 2

what is the prevalence and mean onset of bipolar 1

Answer 2

1-2% and

usually before 30- mean age of first mood episode is 18

Question 3

what mood disorder should always be include in differential of psychotic patient

Answer 3

bipolar I (cannot be bipolar II if psychotic features present)

Question 4

what are the genetics of bipolar I

Answer 4

1st degree relatives 10x likely to develop illness
monozygotic twin concordance 40-70%
dizygotic twin concordance 5-25

Question 5

what has the highest genetic link of all major psychiatric disorders

Answer 5

BIPOLAR I

Question 6

what is rapid cycling

Answer 6

occurrence of 4 or more mood episodes in 1 year (major depressive, hypomanic, or manic)

Question 7

untreated manic episodes generally last how long

Answer 7

months

Question 8

90% of people after one manic episode will have a repeat episode when

Answer 8

within 5 years

the course is usually chronic with relapses
as disease progresses, episodes may occur more frequently

Question 9

what helps decrease risk of relapse in bipolar I

Answer 9

maintenance treatment with mood stabilizing medications b/w episodes

Question 10

what is the suicide correlation with bipolar

Answer 10

25-50% of people with bipolar attempt suicide

10-15% die by suicide

Question 11

whale the side effects of lithium

Answer 11

weight gain
tremor
GI
fatigue
cardiac arrhythmias
seizures
goiter/hypothyroidism
leukocytosis
coma (in toxic doses)
polyuria (nephrogenic diabetes insipidus)
polydipsia
alopecia
metallic taste

Question 12

what mood stabilizer reduces risk of suicide

Answer 12

lithium

Question 13

what drugs are good for rapid cycling bipolar and that with mixed features

Answer 13

carbamazepine

valproic acid

Question 14

what is the role of ECT in bipolar patients

Answer 14

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

Question 15

what is best treatment for a pregnant women who is having a manic episode

Answer 15

ECT

good alternative to antipsychotics and can be used relatively safely in all trimesters

Question 16

what is gold standard treatment for bipolar

Answer 16

lithium (reduction of suicide)

Question 17

a patient with history of postpartum mania has high risk of what and what should be done about it

Answer 17

relapse with future deliveries

should be treated with mood stabilizing agents as prophylaxis

Question 18

what is the DSM V criteria for Bipolar II

Answer 18

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)

Question 19

what has better prognosis bipolar I or II

Answer 19

bipolar II likely

Question 20

what is bipolar with anxious distress

Answer 20

feeling keyed up/tense
restless
difficulty concentrating
fears of something bad happening
feelings of loss of control

Question 21

what is bipolar with mixed features

Answer 21

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

Question 22

what is bipolar with melancholic features

Answer 22

(during depressed episode) characterized by
ANHEDONIA
early morning awakenings
depression worse in the mornings
psychomotor disturbances
excessive guilt
anorexia

Question 23

what is bipolar with atypical features

Answer 23

(during depressed episode) characterized by
hypersomnia
hyperphagia
reactive mood
leaden paralysis
hypersensitivity to interpersonal rejection

Question 24

what is bipolar with permpartum onset

Answer 24

hypomanic or manic symptoms occurring during pregnancy or 4 weeks following delivery