Mood. Disorders And Suicide Management Part 2 Flashcards
Disorders in which high mood is a common theme:
Bipolar 1 disorder
Bipolar 2 disorder
Cyclothymic disorder
What are diagnostic criteria of BP1 disorder?
A person must experience atleast 1 manic episodes
Note: must people also experience a depressive episode, but this is not necessary for the BP1 diagnosis, despite the term bipolar
Mania occurs without having a history of MDEs
Or
Mania occurs with a history of MDEs
What are the symptoms of a manic episode?
Abnormally elevated mood (or irritability) AND increased activity or energy PLUS at least 3 additional symptoms:
- inflated self-esteem/grandiosity
- decreased need for help
- pressured speech
- flight of ideas(and/or racing thoughts)
- distractibility
- Increased goal-directed activity or psychomotor agitation (purposeless activity)
- Excessive involvement in risky activities
Without naming symptoms, what other requirements are needed for manic episode diagnosis?
Symptoms of manic episode must:
-Last at least 1 week (or any duration if hospitalization is required)
-cause marked functional impairment
If hallucinations/delusions occur, then diagnose BPI with mood
- Mood-congruent psychotic features
- Mood-incongruent psychotic features
What are the differentials of Bipolar 1 disorder?
- rule out medical condition
- rule out substance intoxication(e.g. cocaine, amphetamine)
Describe the course of illness of Bipolar 1 disorder
- Manic episodes occur directly before/after an MDE
- Manic episodes last approx. 3 months
Describe the etiology of Bipolar 1 episode
Genetic
- One of the most heritable psychiatric disorders
- Specific genes are unknown
- Family history of BP1 is useful for diagnosis and prognosis
Neurochemical
-Manic episodes involve increased monoaminergic activity, especially of dopamine
-Recall that MDD results from under activity of the monoamines
Describe treatment for BP1 disorder
Mood stabilizers: drugs that level the highs and lows of bipolar disorders
- lithium
- Some anticonvulsants and antipsychotics
ECT- helps with both manic and depressive phases
Psychotherapy
Notes:
Antidepressants: are not FDA approved for BP depression
-they are contraindicated due to risk of manic induction
-if used off-label, then a mood stabilizer is added to help prevent the mood swing
Medication non-compliance: during manic episodes is common due to patients’ dislike of feeling blunted
How is psychotherapy used to treat Bipolar 1 disorder?
Used for secondary issues (e.g., self esteem, occupational/marital problems)
-Not used to treat primary symptoms of Bipolar 1
What are diagnostic criteria of bipolar 2 disorder?
A person experiences atleast 1 MDE and at least 1 hypomania episode(alternating MDE and hypomania)
What are the symptoms of a hypomania episodes?
- Hypomania and mania have the same symptoms but of different severity
- Mania causes “marked” impairment in functioning; hypomania does not
- Mania can cause psychosis; hypomania cannot
- Mania can result in hospitalization; hypomania cannot
- change in mood must be “unequivocal” and “uncharacteristic” of person
- Hypomania episodes must last 4 or more days
How can bipolar 2 disorder be treated?
Mood stabilizers
- use those stabilizers that are particularly effective in treating the depressed phase of BPII
- MDEs are the more problematic phase than hypomania episodes
What is cyclothymic disorder?
- For 2 or more years, a person experiences periods of hypomania symptoms that fluctuate with periods of depressive symptoms
- Criteria for an MDE or a manic episode have never been met
Cyclothymia is similar to bipolar 1, but the mood shifts are not as extreme
What is the course of cyclothymia?
The person may ultimately have an MDE or manic episode, which changes the diagnosis from cyclothymia to a bipolar disordering
How can cyclothymia be treated?
Mood stabilizers( as for BP1)
Explain the relevance of suicide
Suicide and suicide attempts are common
- suicide is one of the top 5 leading causes of death for most age ranges - Attempts are exponentially more common than completed suicides
Many suicidal patients have given warning signs that were overlooked by family, friends, and their physicians
List mental health risk factors for suicide
Mental health
- depression
- other mental illnesses(e.g., schizophrenia, eating disorders)
- substance abuse
- hopelessness
- impulsivity
- prior suicide attempt
Give the contextual risk factors to suicide
- exposure to suicidal behavior(e,g., family history)
- access to lethal means (firearms)
- lack of social support
- losses(e.g., financial, releationship)
- medical illnesses
- being victimized
Give the demography risk factors of suicide
Age
-Older age (atleast 75) is associated with increased completion rate of suicide
Gender
-Males are more likely to COMPLETE suicide due to lethality of suicide method
-Femakes are more likely to ATTEMPT
What is the first thing to do in suicide management?
- Ask about suicidal ideation
- ask direct questions(asking doesn’t put the idea in their heads) Do you feel life is worth Living? Do you think you would be better off dead?
- ask about frequency and duration of thoughts
- ask direct questions(asking doesn’t put the idea in their heads) Do you feel life is worth Living? Do you think you would be better off dead?
How Often do You have these thoughts? How long have you been having these thoughts?
What is the second thing to be done in suicide management?
Evaluate the severity of suicidal intent
- suicidal plan
- presence, specificity and lethality of plan
- availability of means
-preparations for death
-Have you taken steps towards taking your own life?
Stocking pills, getting a gun
-making a will, getting affairs in order, giving possessions away, suicide nite, saying goodbye
-prior attempts
What is the third thing to do in suicide management?
Evaluate behavioral controls
What stops the person from acting on these thoughts?
- reasons for living(e.g. religion, children)
- support system
Is the person on drugs/alcohol?
-substance use increases suicide risk due to diminished inhibition
What is the 4th thing to do in suicide management?
Consider mental health, contextual and demographic risk factors
What is a suicidal action plan?
-any suicidal ideation is a basis for suggesting treatment is a basis for suggesting treatment
General risk levels
- low, moderate, high levels
- action plans for low-risk and high-risk situations are clearer
- assessment of risk levels is imprecise and involves clinical judgement
Describe a low risk action plan
Low risk
- non-specific thoughts of suicide with few risk factors
- refer for out-patient patient psychotherapy and/or evaluation for antidepressant medication
Describe a high risk action plan
- specific plan for suicide with many risk factors
- Need for medications and/or psychotherapy immediately in an in-patient setting
- hospitalization:voluntary or involuntary (engage police to assist, if involuntary)
Describe a moderate risk action plan
Suicide risk is present but crisis intervention is not needed
-refer for out-patient psychotherapy and/or evaluation for antidepressant medication
- create a safety plan
- a document that supports and guides a person to help them avoid a suicidal crisis
