Mania Flashcards
What is the “next step” diagnostically for a patient who presents to the emergency department with symptoms of mania?
- Urinalysis for drugs
- Blood alcohol level
What is the best initial treatment for an emergent presentation of mania?
- Admission to the hospital
- Prescribe mood stabilizer with atypical antipsychotic
What is the lifetime prevalence of Bipolar I?
2-3%
What is the lifetime prevalence of Bipolar II?
5%
What are the various classifications of bipolar disorder?
- with psychotic features
- with melancholic features
- with atypical features
- with catatonic features
- rapid cycling (4 episodes/year
- mixed state (depression and mania/hypomania)
What should be on the differential diagnosis for mania?
- substance induced mood disorder
- medical condition
- bipolar disorder
- Schizophrenia
- Schizoaffective disorder
What medications/drugs can cause manic-like behavior?
- Corticosteroids
- Levodopa (Dopamine)
- Cocaine
- Antidepressants
- Sympathomimetics
- Bronchodilators
What medical conditions are associated with manic-like behavior?
- Metabolic disturbances => hemodialysis
- Infections
- Neoplastic diseases
- Seizures
What are the first line mood stabilizers for bipolar disorder?
- Lithium and valproate
Which mood stabilizer is best for bipolar disorder presenting with depression?
Lamotrigine
Which drug can be used as a short term until the mood stabilizer and antipsychotic take effect?
Benzodiazepine
What is DIG FAST?
Symptoms of Mania => need at least 3 for 1 week (4 days if hypomania) Distractibility Insomnia/impulsive behavior Grandiosity Flight of ideas/Racing thoughts Activity/agitation Speech (pressured) Thoughtlessness
What is a mixed episode?
- Criteria for both a manic and major depressive episode are met
- Symptoms must be present nearly every day for at least 1 week
- Irritability is the predominant mood state in mixed episodes
- Generally poorer response to lithium; anticonvulsants may help
What are the most basic requirements for bipolar I?
- Generally includes episodes of mania and major depression
- HOWEVER, major depression is not required for diagnosis
What is rapid cycling?
- Occurrence of four or more mood episodes in 1 year
