Lecture 5-Bipolar

Question 1

Which best explains (D)ysthymia VS (C)yclothymia?

a. D is acute low level depression and C is acute low level mania
b. D is chronic low level depression and C is chronic low level mania
c. D is acute low level depression and C is chronic low level mania
d. D is chronic low level depression and C is acute low level mania

Answer 1

b. D is chronic low level depression and C is chronic low level mania

Question 2

Which psychiatric disorder affects more of the general population?

a. Major Depression
b. Bipolar 1 Disorder
c. Bipolar 2 Disorder
d. Cyclothymia

Answer 2

a. Major Depression

Question 3

What is psychomotor retardation?

a. Depression causes IQ to lower on IQ tests because depression causes poor concentration and the patient makes errors on the test
b. Depression causes a psychological thinking process that acts like a motor with pistons where thoughts speed up and slow down in alternating fashion
c. Depression causes the patient to feel and act slowed down
d. Depression causes the patient to feel and act psycho and be violent

Answer 3

c. Depression causes the patient to feel and act slowed down

Question 4

What is mania? What is the minimum number of days for something to be mania?

Answer 4

Distinct, abnormal, elevated (happy), expansive (or irritable mood) x 7 days minimum.

At least 3 symptoms must be present for at least 2 weeks:

Increased self esteem/grandiosity (invincible & inflated)

Decreased sleep

Increased speech

Racing thoughts

Distractibility

*Increased activity (and energy is key for DSM 5)
Increased dangerous impulsivity

Question 5

Mnemonic for mania?

Answer 5

Down The Rack HIGH

Distractible

Talkative

Racing thoughts

Hyperactive

Impulsive

Grandiose

hyposomnic ((low sleep))

Question 6

What is hypomania? How many days must it be present for? Does it cause dysfuction like normal mania?

Answer 6

Milder mania: Same symptoms as mania

At least 4 days or more

Not severe enough to cause marked functional impairment

Question 7

How long does a major depressive episode have to occur in bipolar?

Answer 7

More than 2 weeks

Question 8

What is bipolar?

Answer 8

Bipolar disorder is characterized by transitions between depression and mania

Question 9

Mixed episode =

Answer 9

mania with major depression

Question 10

Bipolar 1 =

Answer 10

Mania +/- major depressive episode (MDE)

Bipolar 1 does not need to have depression.

Question 11

Bipolar 2 =

Answer 11

hypomania +/- MDE

*MUST HAVE hypoMANIA, do not need to have depression

Question 12

Cyclothymia? Time definitions?

Answer 12

Hypomania (2 yrs) + MINOR depression

Very succesfull businessmen and artists have this, never see a shrink

Question 13

(T/F) Bipolar people are seductive, sexually active, more divorce, and job loss, and can become angry easily?

Answer 13

True

Question 14

Biological basis of bipolar? Neurotransmitters? Genetics? Kindling hypothesis?

Answer 14

Altered neurotransmitter activity (Increase of DA, SR, NE)

Monoamine Receptor Deficiency theory (opposite of depression)

Genetics (high association)

Kindling Hypothesis (symptoms can grow)

• Too much neuronal firing in the limbic system
• Seizure and anti-epilepsy drug model via Na++ channel blockade

Question 15

Women _ Men in Bipolar 1

Bipolar 2; women _ Men

Answer 15

=; >

Question 16

Name psychosocial factors of bipolar.

Answer 16

Psychosocial Factors
Low self esteem, negative outlook, Learned helplessness, Catastrophic loss**, demeaning parents, peers can yield denial and fantasy defenses to occur = mania

Stress can increase mania despite what book says:

• Stress can lower compliance
• Disrupt sleep and circadian rhythm
• Increase substance abuse

Question 17

Usually we do ___ give antidepressants for bipolar, but how would we give them to a bipolar patient?

Answer 17

not;

If you have to use antidepressants, make sure a mood stabilizer is used first to help prevent antidepressant alone from causing increased mania and instability

Question 18

What are two major treatments for bipolar?

Answer 18

Antipsychotics & lithium- max

Question 19

What do antipsychotics for bipolar block?

Answer 19

They block the dopamine-2 receptor which treats mania or helps prevent it

All block 5HT2a receptors which treats depression

Question 20

_____ works during depressed phase, but not manic phase of bipolar.

Answer 20

Psychotherapy

Question 21

What are some anti maniac agents?

Answer 21

Lithium- provides Ca++ membrane stability and promotes neuronal health and protective factors. Lithium hurts kidneys and thyroid. Increases WBC.

Divalproex- increases GABA activity/tone. Hurts pancreas, liver & platelets. So lifelong blood draws to make sure not hurting organs.

Carbamazepine- blocks Na+ channels and promotes neuronal health. Suppresses bone marrow.

Atypical Antipsychotics- All block D2 receptors and ? Increase neuronal health and connectivity:
Risperidone, Aripiprazole
Olanzapine, Asenapine
Quetiapine

Question 22

A patient has mania and you want to prescribe a treatment. Which property below would you like to manipulate by way of prescribing?

a. Block Na++ channels to slow neuronal firing to slow limbic system
b. Stimulate D2 receptors to increase limbic activity
c. Increase NE release robustly into synapse

Answer 22

a. Block Na++ channels to slow neuronal firing to slow limbic system

Question 23

A 40 yr old patient has had Bipolar 2 disorder for 15 years but comes to your office in a fully manic state that has lasted at least 14 days. What is the correct diagnosis?

Cyclothymia

Bipolar 2

Bipolar 1

Bipolar 3

Answer 23

Bipolar 1