Group- Bipolar Flashcards
- List the diagnostic criteria for mania, and bipolar I disorder.
Mania: Manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes
Bipolar I: Distinct period of abnormally and persistently elevated, expansive or irritable mood with increased goal directed activity or energy, lasting at least 1 week and present most of the day; 3 or more of the following present
a. Inflated self-esteem or grandiosity
b. Decreased need for sleep
c. More talkative than usual or pressure to keep talking
d. Flight of ideas or subjective experience that thoughts are racing
e. Distractibility, as reported or observed
f. Increased goal-directed activity or psychomotor agitation, impulsive
g. Excessive involvement in activities that have a high potential for painful consequences
Mood disturbance severe enough to cause impairment and not attributable to physiological effects of a substance, medication or another med. condition
- List the diagnostic criteria for hypomania, and bipolar II disorder.
Hypomania: less severe form of mania that does not cause functional impairment
Bipolar II disorder: includes at least one hypomanic episode and at least one major depressive episode, but never a manic episode, typically depressive episodes are more severe and troubling, often irritability is a prominent symptom
Same characteristics as mania, lasting at least 4 consecutive days, 3+ symptoms are persistent or represent a noticeable change in behavior
- Describe the epidemiology, pathophysiology, and risk factors.
lifetime prevalence is 4%, only ⅓ patients ever dx., women 3:2, median age 25yo; common co-morbid substance use disorder (60%) or anxiety disorders (50%); 10-15% complete suicide
pathophysiology: low levels of N-actylasparatate in PFC, anterior cingulate cortex and hippocampus
elevated cortisol due to HPA dysfunction
risk: sensitive to sleep disturbance, more common in families with high expressed emotion
- Describe the clinical presentation, and prognosis of bipolar disorder.
presentation: mania (abrupt change in mood- elevated, expansive or irritable, often labile)
grandiosity/psychosis, loose associations
decreased need for sleep, speech is pressured, racing thoughts, disorganized thoughts and impulsivity
- Explain what mixed features are.
a mood episode that has simultaneous symptoms of major depressive episode and symptoms of mania- dangerous as hopelessness and sucidality are coupled with impulsivity
- Recognize the substance and medication induced and other medical etiologies of mania.
endocrine, neurological, neoplasia, cerebrovascular disease and infection
psychostimulants (cocaine and amphetamines), antidepressants, glucocorticoids and antibiotics
- List the treatments available for acute symptoms of bipolar disorder- psychotropic medications.
acute mania: Lithium, anticonvulsants, valproic acid and oxcarbazepine (atypical antipsychotics: risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole)
acute depression: antidepressants should always be prescribed with mood-stabilizer: lithium, atypical antipsychotics, lamtrigine (anticonvulsant)
BZD used to address anxiety and agitation
electroconvulsive therapy can result in rapid resolution of severe or refractory episodes of depression or mania
acute bipolar may require rebuilding of relationships or vocation rehab or financial counseling
- List the treatments available for bipolar disorder, specifically maintenance treatment.
primary goal of maintenance tx. to prevent kindling (episodes that become more frequent and more severe/refractory
lithium and lamotrigine most likely to prevent recurrence, valproic acid and various atypical antipsychotics (⅔ patients are not fully adherent during 1st year of treatment)
Discuss psychosocial interventions that are appropriate for bipolar disorder and stabilization of daily rhythms.
psychosocial interventions: increasing social support, teaching importance of regulating sleep-wake sycles, teaching coping methods: interpersonal and social rhythm therapy (keeping tract of time of day of important events)
