Depressive and Bipolar Disorders

Question 1

Self-perception is negative, world is experienced as hostile, expectations of failure/suffering in future

Answer 1

Cognitive Triad of Depression (Beck)

Question 2

Achieve remission (2 months - partial, beyond 2 months - full), continuation phase (sustained remission for more than 2 months), maintenance phase (prevent recurrance), discontinuation phase (treatment 9-12 months free from recurrence)

Answer 2

Phases of depression treatment

Question 3

Cyclic mood diagnosis with predominant mood being depression or euphoria. Often preceded by several major depression episodes before first manic episode. Prevalence equal between males and females but males tend to experience more manic episodes.

Answer 3

Bipolar and related disorders

Question 4

Distinct period of abnormally and persistent elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of day nearly every day and is severe enough to cause marked impairment in mood, cognition, and perception (function).

Answer 4

Mania - acute (Stage II)

Question 5

Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased energy, lasting at least 4 days and present most of day but the episode is not severe enough to cause marked impairment in functioning or require hospitalization.

Answer 5

Hypomania (Stage I)

Question 6

Criteria met for at least one major manic or mixed episode.

Answer 6

Bipolar I

Question 7

Criteria met for at least one major hypomanic episode and depressive episode.

Answer 7

Bipolar II

Question 8

Severe clouding of consciousness and intensified symptoms of acute mania, may become psychotic and requires hospitalization.

Answer 8

Delirious mania (Stage III)

Question 9

Appearance and affect: gaudy and flamboyant, poor personal grooming; behavior: boundless energy, animated/dramatic conversational style, increased motor activity, provocative, demanding, minimal sleep, not eating; feelings: elated, low tolerance for frustration, extremely irritable, angry/verbally abusive; perceptions: usually normal but may have hallucinations that match affect; thinking: grandiosity, flight of ideas, impaired judgement, paranoia (later stages), decreased attention but memory, calculations, and orientation intact.

Answer 9

MSE exam findings for mania

Question 10

First-line treatment and gold standard in adults with bipolar I disorder. Start at 300-600mg daily and titrate to therapeutic level between 0.8-1.5 mEq/L for acute stabilization. Monitor trough levels every 5-10 days during titration.

Answer 10

Lithium

Question 11

Neuroprotective and reduces risk of suicide in bipolar I. Long-term may cause weight gain, fine tremor and kidney dysfunction/failure.

Answer 11

Lithium

Question 12

Levels over 1.5 mEq/L with symptoms of course tremor, NVD, confusion, ataxia, slurred speech, lethargy. Hold dose for 1 day and reevaluate.

Answer 12

Lithium toxicity (mild to moderate)

Question 13

Levels over 2.0 mEq/L with profound CNS depression, arrhythmias, seizures, coma

Answer 13

Lithium toxicity (severe)

Question 14

May be used as monotherapy or in addition to lithium, especially for rapid cyclers, dosed at 250-1,500mg/day. Requires routine blood levels and has side effects of weight gain and alopecia.

Answer 14

Depakote (divalproex sodium) or Depakene (valproic acid)

Question 15

Least likely antidepressant to cause cycling in bipolar disorder.

Answer 15

Bupropion