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Behavioral Health > Clin Med - Bipolar > Flashcards

Clin Med - Bipolar Flashcards

1
Q

Defects that may contribute to pathophysiology of bipolar disorder

A
  • Involvement of cortical, limbic, basal ganglia, cerebellar structures
  • Defects in mitochondrial energy production
  • Abnormalities in electron transport chain and G-protein coupled receptor signaling
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2
Q

What is likelihood a first-degree relative of a patient with bipolar disorder will also develop the disease?

A

7 times more likely

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3
Q

Is bipolar I or bipolar II more common in females?

A

Bipolar II MC in females

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4
Q

What is the one symptom that automatically gets a diagnosis if Bipolar I disorder?

A

manic episode

- if EVER have, dx is bipolar I

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5
Q

Other than manic episode, what are other sx seen in bipolar I disorder?

A
  • hypomanic episode

- major depressive episode (common but NOT required for dx)

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6
Q

DSM description and time frame for dx of manic episode?

A

At least one week (7 days) period

  • abnormality, persistently elevated, expansive, irritable mood AND
  • Abnormally and persistently increased goal-directed activity or energy
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7
Q

What must the manic episode mood disturbance in bipolar I dx be severe enough to do? (3)

A
  • Cause marked impairment in social or occupational functioning
  • Necessitate hospitalization to prevent harm to self or others
  • Psychotic features (hallucinations, delusions, etc.)
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8
Q

For both manic and hypomanic dx, three of the following sx (four if the mood is only irritable) must be present:

A
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than normal or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility
  • Increased goal-directed activity (socially, work/school, sexually) or psychomotor agitation
  • Excessive involvement in activities that have a high potential for painful consequences (shopping spree, sex, bad business investments)
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9
Q

What must sx NOT be attributed to to be dx as bipolar I

A

physiological effects of substance or other med condition

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10
Q

When should use specifier “with rapid cycling” ?

A

only used when pt with bipolar I disorder have multiple mood episodes within 1 year

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11
Q

What must be present for dx of bipolar II dx

A

At least one current or past hypomanic episode AND criteria for one current or past major depressive episode

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12
Q

What cannot have ever occurred for dx of bipolar II ?

A

manic episode (bc then is bipolar I)

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13
Q

Time frame for hypomanic episode

A

min 4 days (bipolar I is 7 days)

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14
Q

Describe activity of hypomanic episode

A
  • Distinct period of abnormally and persistent elevated, expansive, or irritable mood and abnormally and persistently increased activity of energy
  • Uncharacteristic of individual with not symptomatic
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15
Q

What is hypomanic episode not severe enough to cause (2)

A
  • Marked impairment in social or occupational functioning OR

- Hospitalization

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16
Q

Are psychotic features present in bipolar II?

A

NO, if psychotic features then bipolar I

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17
Q

what is often the dominant mood in bipolar II?

A

depression

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18
Q

Describe onset of bipolar II

A
  • Mean onset age is mid 20s
  • Most often begins with depressive episode, not recognized as bipolar II until hypomania episode occurs later. May experience several episodes of depression prior to first recognized hypomanic episode
  • May be preceded by anxiety, substance abuse, eating disorders (complicate detection)
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19
Q

Differences between mania and hypomania

A

Mania
- 1 week, more severe, more impairment, more severe consequences

Hypomania
- 4 days, less severe, less impairment, less severe consequences

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20
Q

Why is bipolar disease often misdiagnosed as major depressive disorder?

A
  • Patients often fail to mention presence of manic or hypomanic (MC) symptoms in past or current episode
  • Screening for bipolar disorders in patients who present with depressive sx is rarely done
    • Av 8 years from time of first presentation to correct dx of bipolar disorder
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21
Q

Why is bipolar II more frequently misdiagnosed as major depressive disorder than bipolar I?

A
  • Feel well when hypomanic
  • No psychotic sx (not hospitalized, no records)
  • May present as irritability not euphoria when mild hypomania
  • May present as exaggerated sense of well-being associated with elevated mood state, not hypomania
22
Q

how is unipolar depression different from bipolar depression?

A

bipolar has presence of manic or hypomanic sx

23
Q

Potential consequence of using antidepressant therapy in a bipolar patient without a concomitant mood stabilizer.

A
  • May worsen course of bipolar disease, esp if concomitant use of a mood stabilizer
  • Contribute to rapid cycling: experience more episodes of illness with progressively shorter periods of wellness and a diminished response to medication
24
Q

What is a good screening tool to ID mood disorders who present with hx of depression?

A

Mood Disorder Questionnaire (MDQ)

25
Q

What is it important to interview an informant (spouse, child, etc.) when dealing with depressive sx?

A
  • so don’t miss bipolar dx
  • Pts may fail to recall manic or hypomanic sx
  • Pt may have no insight into the impact their sx may have had on their functioning
  • Many pt value heightened activity and energy during hypomanic states, don’t report them as pathologic
  • Pts fear stigma associated with bipolar disorder
26
Q

Appearance of depressed state

A
  • Poor/no eye contact
  • Unkempt, unclean, holey, un-ironed, ill-fitting clothes
  • Poor grooming, lack of shaving/washing
  • Depressed affect, slow movement, psychomotor retardation
  • Speaking in low tones, depressed or monotone voice
27
Q

Appearance of hypomanic state

A
  • Busy, active, involved
  • Energetic, always on the go
  • Planning and doing things
  • Others notice energy change and levels
28
Q

Appearance of manic state

A
  • Behavior opposite of depressed phase
  • Hyperactive and hypervigilant
  • Restless, energized, active
  • Talk and act fast
  • Clothes put on in haste, disorganized
  • Garments are bright, colorful, garish (stand out in crowd)
29
Q

Affect and mood in depression

A
  • Sad, lost, vacant, isolated

- Hopeless and helpless

30
Q

Affect and mood in hypomania

A

up, expansive, often irritable

31
Q

affect and mood in mania

A
  • Inappropriately joyous, elevated, jubilant
  • Euphoric
  • Annoyance and irritability, esp if mania has been present for sig length of time
32
Q

Thought content depressed

A
  • Reflect sadness
  • Preoccupied with negative ideas
  • Focus is on death and morbid persons
  • Many think about suicide
33
Q

Thought content hypomanic

A
  • optimistic
  • forward thinking
  • positive attitude
34
Q

Thought content manic

A
  • Expansive, optimistic thinking
  • Excessively self-confident and/or gradndiose
  • Rapid production of ideas and thoughts
  • Perceive minds as being very active
  • Perceive self as highly engaging and creative
  • Highly distractible, quickly shift from one thought/topic to another
35
Q

Perceptions depressed

A
  • Delusion of having sinned, accompanied by guilt and remorse
  • Feels utterly worthless and should live in total deprivation/degradation
  • Some feel paranoia or persecutory delusions
36
Q

perceptions hypomanic

A

No perceptual disturbances

37
Q

Perceptions manic

A
  • 75% have delusions

- perceptions of power, prestige, position, self-worth, glory

38
Q

Suicide and self destruction depression

A
  • *High rate of suicide
  • Do they have thoughts of hurting themself? Plans?
  • More specific the plan higher danger
  • Risk higher as emerge from depression (have more energy)
39
Q

Suicide and self destruction manic and hypomanic

A

low risk of suicide

40
Q

Homicide, violence, aggression depression

A
  • Suicide is major risk

- Homicide followed by suicide is risk if see world as hopeless and helpless for themselves and others

41
Q

Homicide, violence, aggression hypomania

A
  • Irritability and aggressiveness

- Pushy and impatient with others

42
Q

Homicide, violence, aggression mania

A
  • Openly combative and aggressive
  • No patience/tolerance for others
  • Demanding, violently assertive, highly irritable
  • If have delusions, might have homicidal elements
  • Act out grandiose believe others must obey their command, wishes, directives
  • *If delusions become persecutory, may defend self in homicidal fashion
43
Q

Judgement and insight depression

A
  • Clouded and dim
  • Fail to make important decisions bc so down
  • Planning is difficult: no tomorrow
  • Forgetful
  • Little insight into own behavior sometimes
44
Q

Judgement and insight hypomanic

A
  • Good but expansive judgment
  • Too many tasks, over-involved
  • Distractibility impairs judgment
  • Little insight into driven qualities
  • See self as productive and conscientious
45
Q

Judgement and insight manic

A
  • Seriously impaired judgment is HALLMARK sx (ex. invest family fortune in questionable funds)
  • Professionally over-involved in work activities or co-workers
  • Don’t listen to feedback, suggestions, advice
  • No insight into extreme nature of their demands, plans, behavior
  • Commitment is often only way to contain them ☹
46
Q

When to hospitalize bipolar patient (5)

A
  • Danger to self
  • Danger to others
  • Unable to function, out of control behavior
  • Medication monitoring needed for safety
  • Co-morbid conditions
47
Q

Which bipolar candidates for partial hospitalization of day treatment programs

A

Severe symptoms but reasonable level of control and stable living environment

48
Q

Four major goals of the outpatient treatment of a bipolar patient

A
  1. Establish a way to manage areas of stress in life
  2. Stabilize medications to achieve benefit and minimize adverse effects
  3. Develop and maintain therapeutic alliance
  4. Education patient and family about disease and dangers of substance abuse, relapse, role of meds, support groups
49
Q

Which type of bipolar disease has a worse prognosis

A

Bipolar I

50% experience manic attack within 2 years of initial dx

50
Q

What factors predict a worse prognosis in patient with bipolar disease

A
  • Poor job history
  • ETOH abuse
  • Psychotic features
  • Depressive features between mania and depression
  • male

Behavioral Health (11 decks)

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