MOOD 13

Question 1

Regarding BPAD:

1. Prevalence?
2. M : F ?
3. Average age of onset?
4. Rates of attempted suicide?
5. Rates of completed suicide?

Answer 1

1. Prevalence = 1% of population
2. M = F
3. 19 yo
4. 50%
5. 15%

Question 2

What is the time criteria for a manic episode?

What is the time criteria for a hypomanic episode?

Answer 2

Manic = 7 days or less if Hospitalized.

Hypomanic = 4 days

Question 3

How many depressive symptoms to you need in addition to manic or hypomanic episodes to have specifier “with mixed features?”

Answer 3

3 symptoms.

Question 4

Bipolar 1 or 2 can be “rapid cycling.” What is the dx criteria?

What is the criteria for “ultra rapid cycling?”

What is the criteria for “ultra ultra rapid cycling?”

Answer 4

Rapid cycling = Any 4 mood episodes (mania, hypomania or depressed) in 1 year.

Ultra rapid cycling = multiple cycles in a month

Ultra ultra rapid cycling = Multiple cycles a day

Question 5

What is the criteria for BPAD with Permpartum onset?

Answer 5

Onset of episode during pregnancy or 4 weeks AFTER pregnancy.

Question 6

What is the diagnostic criteria for Cyclothymia?

Answer 6

2 years (1 year in children/adolescents) where you have numerous mood episodes that don’t meet full criteria for hypomanic or depressive episodes.

Symptoms for 1/2 the time (of 2 years) and symptom free duration is no longer than 2 months.

Question 7

What are the FDA approved MAINTENANCE MEDICATIONS for BPAD?

What about as adjunctive for maintenance?

Answer 7

Maintenance “A ROLL”

Aripiprazole
Risperdal Consta
Olanzapine 
Lamotrigine 
Lithium 

Adjunctive for maintenance:
Quetiapine
Ziprasadone

Question 8

What medications are FDA approved for ACUTE MANIA?

Answer 8

Lithium
VPA
Carbamazepine

Abilify
Asenapine
Quetiapine
Ziprasidone

Caripiprazole
Olanzapine
Risperdal

Think “LVC + AAQZ COR”

Question 9

What are the FDA approved medications for bipolar DEPRESSION?

What are the FDA approved medications for MIXED?

Answer 9

DEPRESSION:
Quetiapine
Lurasidone
Olanzapine + Fluoxetine

MIXED:
VPA
Carbamazepine
Abilify 
Asenapine 
Quetiapine 
Ziprasidone 
Caripiprazine

think “VC + AAQZ C” (MANIA is (L)VC AAQZ C(OR))

Question 10

Describe the 3 MOA of Lithium

Answer 10

1. Blocks Inositol monophosphatase, modulating 2nd messenger system.
2. Down regulates excitatory NT glutamate and DA
3. Up regulates inhibitory NT GABA.