Mood Disorders: Bipolar Disorder

Question 0

What’s bipolar NOS?

Answer 0

Bipolar disorder not-otherwise-specified. (a little vague. Could be just a little hypomanic… could be just in response to medication)

Question 1

What’s the major difference between Bipolar Type 1 and Type 2?

Answer 1

Type 1: at least one manic episode

Type 2: hypomania and depression, no manic episodes.

Question 2

What’s schizoaffective disorder? How does it differ from bipolar disorder?

Answer 2

Like bipolar - can swing between mania and depression, but these patients don’t return to baseline between episodes.

Question 3

What are some non-psychiatric cause of mania?

Answer 3

Medication (esp. glucocorticoids)

Non-mental illness.

Question 4

How long must manic symptoms last for it to be considered a “manic episode”?

Answer 4

7 days (but this is admittedly somewhat arbitrary)

Question 5

What are 7 features of mania? How many must you have for it to be considered a manic episode?

Answer 5

Grandiosity
Decreased need for sleep
Pressured speech
Racing thoughts / flight of ideas
Distractibility
Increased goal-directed activity
Poor judgment/risky behaviors (sex, spending, gambling, etc.)

Question 6

About how common are psychotic in mania? Are hallucinations or delusions more common?

Answer 6

About 58% of patients have at least 1 psychotic symptom.

Delusions are much more common than hallucinations.

Question 7

4 reasons that you call something mania and not hypomania?

Answer 7

Psychotic symptoms (delusions/hallucinations)
Social / work impairment
Hospitalization
Longer duration (hypomanic episodes are shorter)

Question 8

What are 4 clinically important subforms of bipolar disorder? Why is classification important?

Answer 8

Rapid cycling
Mixed features (mania and depression at same time)
Seasonal (depression in fall/winter, mania in spring/summer)
With psychotic symptoms
Classification guides prognosis and treatment.

Question 9

What’s the major reason there’s a lot of variation in the estimates for prevalence of bipolar disorder?

Answer 9

Criteria for “hypomania” vary widely, and thus so do Bipolar II prevalence estimates. (Bipolar I prevalence is pretty consistently put at 0.5 - 1.0%)

Question 10

Of the time that bipolar patients are symptomatic, what’s the relative fraction of mania / depression? Does it vary between bipolar I and bipolar II?

Answer 10

Depression predominates in both.
Bipolar I patients spend more time manic (20% manic/hypomanic, 13% mixed) vs.
Bipolar I patients with only 2.5% hypomanic, 4.5% mixed.

Question 11

Median age of onset of bipolar disorders? 90% have onset before what age?

Answer 11

Median age of onset: 17.5 year
90% have onset before 30 years.
It’s a condition that begins in adolescents and young adults.

Question 12

How does age of onset relate to severity / co-morbidities?

Answer 12

The early the onset, the more severe it usually is.

Question 13

How heritable is bipolar disorder: MZ concordance? Risk for first degree relatives?

Answer 13

Very heritable.
50-70% concordance in MZ twins.
1st degree relatives have 10x risk of mania, 2x risk of depression.

Question 14

Common co-morbidities of bipolar disorder? (4 things)

Answer 14

Anxiety, substance abuse, antisocial behavior, conduct disorders.

Question 15

Why does it take so many people a long time (avg = 10 years) to get properly diagnosed with bipolar disorder? Effect on treatment?

Answer 15

It’s often initially misdiagnosed as depression. (which it can look like before the patient has a manic episode)
Treatment for depression tends not to work well for bipolar disorder.

Question 16

Does bipolar disorder or major depression have a higher societal burden? Which has a higher rate of completed suicide?

Answer 16

Bipolar causes more days of work lost, and more completed suicides.

Question 17

What’s the main instrument for screening for bipolar disorder?

Answer 17

Mood Disorder Questionnaire (MDQ)

Question 18

What’s the goal of treatment for bipolar disorders, especially bipolar I?

Answer 18

Mood stabilization.

Question 19

3 features that define a mood-stabilizing drug?

Answer 19

Treats acute mania and/or depression.
Reduces recurrence of mania and depression.
Do not make either mania or depression worse.

Question 20

5 mood stabilizing therapies? (4 are drugs)

Answer 20

Lithium salts
Divalproex
Carbamazapine
1st and 2nd Gen. Antipsychotics (but can be pro-depressive)
Electroconvulsive Therapy (ECT) -rarely used.

Question 21

What feature of Bipolar I is easiest to treat: Mania, depression, or mixed episodes?

Answer 21

Mania is the easiest to resolve with treatment. Mixed/cycling is the hardest.

Question 22

Is monotherapy or combination therapy preferred for bipolar disorder?

Answer 22

Combination therapy, but it comes with increased risk of side effects.

Question 23

Do people’s treatment regimen for bipolar disorder usually stay constant or have to be modified?

Answer 23

Usually must be modified.