Mehl. bipolar I and II 03-21 (2) Flashcards
What is mania?
State of intensely elevated, expansive, or irritable mood, often with marked impairment in judgment.
How long does mania usually last?
Usually lasts longer than a week.
What type of dysfunction does mania cause?
Socio-occupational dysfunction.
Give an example of socio-occupational dysfunction due to mania.
The patient works as a dentist and can’t go to work or has problems at work.
Can mania sometimes cause psychotic features?
Yes.
What may be required in severe cases of mania?
Hospitalization.
What is a significant risk associated with mania?
Risk of suicide (incr. 2 arrows)
What does the ‘D’ in DIGFAST stand for?
Distractibility (easily distracted / not able to focus)
Distractibility is a key symptom of mania and hypomania.
What does the ‘I’ in DIGFAST represent?
Impulsivity (e.g., shopping sprees, reckless driving)
Impulsivity can lead to risky behaviors during manic episodes.
What is indicated by the ‘G’ in DIGFAST?
Grandiosity (inflated self-esteem / having sense of special powers or gifts)
Grandiosity is a common feature in manic states.
What does the ‘F’ in DIGFAST stand for?
Flight of ideas (rapidly shifting thoughts/ideas, sometimes with lacking coherence)
Flight of ideas can indicate a manic state where thoughts are disorganized.
What does the ‘A’ in DIGFAST represent?
Activity increase (goal-directed activity; sexual activity; psychomotor agitation)
Increased activity is often observed in manic or hypomanic episodes.
What does the ‘S’ in DIGFAST signify?
Sleep deficit (decreased need for sleep)
A reduced need for sleep is a hallmark of mania and hypomania.
What does the ‘T’ in DIGFAST refer to?
Talkativeness (pressured speech; term means haphazard loquaciousness, sometimes without pausing)
Talkativeness in mania can manifest as rapid and excessive speech.
DIGFAST - the mnemonic for remembering how mania and hypomania present.
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What is hypomania?
A mood state that usually lasts longer than 4 days and does not cause socio-occupational dysfunction. (Q says patient works as dentist + maintains the job no issues).
How long does hypomania typically last?
Usually lasts longer than 4 days.
Does hypomania cause socio-occupational dysfunction?
No, it does not cause socio-occupational dysfunction.
What are the psychotic features associated with hypomania?
Hypomania does not cause psychotic features.
Is hospitalization required during hypomania?
No, it does not require hospitalization.
Bipolar I. When is diagnosed? Cp
Diagnosed if patient has at least one manic episode, with or without a depressive episode.
What is the diagnosis criteria for Bipolar II?
At least one hypomanic episode + at least one major depressive episode. Must never have had a full-blown manic episode.
Bipolar II. The reason at least one major depressive episode is required for diagnosis is because a hypomanic episode might be part of cyclothymia, rather than bipolar II, if the patient has merely experienced depressed mood in the past without a full-blown depressive episode.
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Bipolar disorder I and II. Tx? 2
Treatment on USMLE is lithium or valproic acid.
Bipolar disorder I and II. Tx - lithium. What adverse can cause? 3
Lithium can cause nephrogenic DI, hypothyroidism, and tremor.
Bipolar disorder I and II. Tx - lithium.n its teratogen. what CP?
It is also a teratogen (causes Ebstein anomaly).
Bipolar disorder I and II. Tx - lithium.
New 2CK NBME has lithium causing serotonin syndrome. Very unusual/odd, but asked.
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Bipolar disorder I and II. Tx - valproic acid. what adverse effects? 3
Valproic acid causes neural tube defects (interference with folate metabolism), tremor, and hepatoxicity.
If the Q gives you increased LFTs + tremor, choose valproic acid over lithium.
