Lecture 5-Bipolar Flashcards
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
b. D is chronic low level depression and C is chronic low level mania
Which psychiatric disorder affects more of the general population?
a. Major Depression
b. Bipolar 1 Disorder
c. Bipolar 2 Disorder
d. Cyclothymia
a. Major Depression
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
c. Depression causes the patient to feel and act slowed down
What is mania? What is the minimum number of days for something to be mania?
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
Mnemonic for mania?
Down The Rack HIGH
Distractible
Talkative
Racing thoughts
Hyperactive
Impulsive
Grandiose
hyposomnic ((low sleep))
What is hypomania? How many days must it be present for? Does it cause dysfuction like normal mania?
Milder mania: Same symptoms as mania
At least 4 days or more
Not severe enough to cause marked functional impairment
How long does a major depressive episode have to occur in bipolar?
More than 2 weeks
What is bipolar?
Bipolar disorder is characterized by transitions between depression and mania
Mixed episode =
mania with major depression
Bipolar 1 =
Mania +/- major depressive episode (MDE)
Bipolar 1 does not need to have depression.
Bipolar 2 =
hypomania +/- MDE
*MUST HAVE hypoMANIA, do not need to have depression
Cyclothymia? Time definitions?
Hypomania (2 yrs) + MINOR depression
Very succesfull businessmen and artists have this, never see a shrink
(T/F) Bipolar people are seductive, sexually active, more divorce, and job loss, and can become angry easily?
True
Biological basis of bipolar? Neurotransmitters? Genetics? Kindling hypothesis?
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
Women _ Men in Bipolar 1
Bipolar 2; women _ Men
=; >
Name psychosocial factors of bipolar.
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
Usually we do ___ give antidepressants for bipolar, but how would we give them to a bipolar patient?
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
What are two major treatments for bipolar?
Antipsychotics & lithium- max
What do antipsychotics for bipolar block?
They block the dopamine-2 receptor which treats mania or helps prevent it
All block 5HT2a receptors which treats depression
_____ works during depressed phase, but not manic phase of bipolar.
Psychotherapy
What are some anti maniac agents?
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
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
a. Block Na++ channels to slow neuronal firing to slow limbic system
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
Bipolar 1
