Lecture 34: Bipolar Disorder Flashcards
What are the DSM-IV diagnoses of bipolar disorder?
- Bipolar type 1 (at least 1 manic episode)
- Bipolar Type II (hypomania and depression; no manic episodes)
- Bipolar NOS (not otherwise specified…neither I nor II)
- Related diagnoses
- cyclothymic disorder
- Schizoaffective disorder
- Mania secondary to medications or illnesses
What are the diagnostic criteria for Mania?
- Distinct Period of abnormally elated or irritable mood (at least 7 days for first episode)
- At least 3 of the following
- grandiosity
- need for sleep
- pressured speech
- infatuation (High school love)
- distractibility
- increased goal-directed activity or agitation
- poor judgement/risky behaviors
- Impairment in occupational and/or social functioning
- Not attributable to a general medical illness or a drug /medication effect
What is the prevalence of psychosis in mania?
58% of patients have at least 1 psychotic symptom
Delusions (typically mood congruent grandiose and paranoid) more common than hallucinations
90% of patients have at least 1 psychotic symptom by self-report
What is the distinguishing factor between mania and hypomania?
Mania is MUCH more disabling
-hallucinations, vocalization and social impairment, and hospitalization = mania
People with hypomania don’t seek treatment
What is distinguishing feature between bipolar I and II?
Bipolar I = mania
Bipolar 2 = DEPRESSION 37 fold more frequent than mania
What is the difference between bipolar I and bipolar II diagnosis?
Bipolar II is heavily dependent on the threshold for hypomania
-when more inclusive criteria are used, up to 50% of people with unipolar depression can be placed within a broader bipolar spectrum
Bipolar II = more depression
What is the significance of cycling?
Cycling between Mania and Depression that is characteristic of bipolar disorder
How heritable is bipolar disorder?
Highly
What are the important subforms of bipolar disorder?
- Rapid cycling (4+ episodes/year)
- means 1st and 2nd generation doesn’t work as well
- Mixed features
- mania AND depression, they can co-occur
- Seasonal pattern
- depression in fall/winter and mania in spring/summer
- With psychotic features
- 60% in manias
- 20% in depressions
What is cyclothymia?
Periods of up and down that are relatively normal
At risk for bipolar disorder
What are Bipolar I disorder comorbidities?
Anxiety
Alcohol dependence
Drug dependence
Adult antisocial behavior
What do mood stabilizers do?
Effective in the acute treatment or stabilization of manic/mixed hypomanic, and depressive episodes
Do NOT induce alternate mood symptoms
-prevent against future relapse or recurrence
What defines mood stabilizer?
- treats acute mania and/or depression
- prevents recurrence of mania and depression
- Does not increase the risk of mania or depression
Do you want to give antidepressants for bipolar I disorder? Significance?
NO YOU DON’T
This is significant because oftentimes, depression is diagnosed vs. bipolar
What is age of onset for bipolar disorder?
17.5 years
What is the difference between bipolar disorder and unipolar depression?
Bipolar disorder is much MORE disabling
MORE psychotic, MORE comorbid
Do bipolar disorder oftentimes get misdiagnosed as unipolar depression? Significance?
Yes, over 50% misdiagnosed
Significance: unipolar depression patients were more likely to have poorer outcomes because anti-depressants don’t work in bipolar disorder
What are the pearls in treatment of bipolar disorder
- Treatment modalities often need to change over time
- Several weeks are required to assess the effect of new treatment
- Optimize mood stabilizers (use more than 1)
- Combination therapy is standard for BPD
- Antidepressant may WORSEN disease course
- Select drug regimens that are well-tolerated and promote compliance
The average bipolar patient has to take how many medications?
3 medications
- 2 mood stabilizer - 1 antipsychotic
What is the association with completed suicide and bipolar disorder?
Bipolar I disorder have higher rates of completed suicide than unipolar disorder
Needs to be considered for treatment
What is the significance of mood disorder questionnaire MDQ?
Used to diagnose bipolar disorder
Used to get history of manias
What are examples of mood stabilizers?
Lithium Valproic acid (anticonvulsant)
What are antimanic therapies?
Lithium Divalproex Carbamazapine First and second generation antipsychotics ECT (rarely)
How long does it take to recover from bipolar depression?
Mania take 8 weeks
Depression takes 6 months
Mixed/cycling = one year
That’s why mania was easier to treat
