Mood Disorders: Bipolar Disorder Flashcards
What’s bipolar NOS?
Bipolar disorder not-otherwise-specified. (a little vague. Could be just a little hypomanic… could be just in response to medication)
What’s the major difference between Bipolar Type 1 and Type 2?
Type 1: at least one manic episode
Type 2: hypomania and depression, no manic episodes.
What’s schizoaffective disorder? How does it differ from bipolar disorder?
Like bipolar - can swing between mania and depression, but these patients don’t return to baseline between episodes.
What are some non-psychiatric cause of mania?
Medication (esp. glucocorticoids)
Non-mental illness.
How long must manic symptoms last for it to be considered a “manic episode”?
7 days (but this is admittedly somewhat arbitrary)
What are 7 features of mania? How many must you have for it to be considered a manic episode?
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.)
About how common are psychotic in mania? Are hallucinations or delusions more common?
About 58% of patients have at least 1 psychotic symptom.
Delusions are much more common than hallucinations.
4 reasons that you call something mania and not hypomania?
Psychotic symptoms (delusions/hallucinations)
Social / work impairment
Hospitalization
Longer duration (hypomanic episodes are shorter)
What are 4 clinically important subforms of bipolar disorder? Why is classification important?
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.
What’s the major reason there’s a lot of variation in the estimates for prevalence of bipolar disorder?
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%)
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?
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.
Median age of onset of bipolar disorders? 90% have onset before what age?
Median age of onset: 17.5 year
90% have onset before 30 years.
It’s a condition that begins in adolescents and young adults.
How does age of onset relate to severity / co-morbidities?
The early the onset, the more severe it usually is.
How heritable is bipolar disorder: MZ concordance? Risk for first degree relatives?
Very heritable.
50-70% concordance in MZ twins.
1st degree relatives have 10x risk of mania, 2x risk of depression.
Common co-morbidities of bipolar disorder? (4 things)
Anxiety, substance abuse, antisocial behavior, conduct disorders.
Why does it take so many people a long time (avg = 10 years) to get properly diagnosed with bipolar disorder? Effect on treatment?
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.
Does bipolar disorder or major depression have a higher societal burden? Which has a higher rate of completed suicide?
Bipolar causes more days of work lost, and more completed suicides.
What’s the main instrument for screening for bipolar disorder?
Mood Disorder Questionnaire (MDQ)
What’s the goal of treatment for bipolar disorders, especially bipolar I?
Mood stabilization.
3 features that define a mood-stabilizing drug?
Treats acute mania and/or depression.
Reduces recurrence of mania and depression.
Do not make either mania or depression worse.
5 mood stabilizing therapies? (4 are drugs)
Lithium salts
Divalproex
Carbamazapine
1st and 2nd Gen. Antipsychotics (but can be pro-depressive)
Electroconvulsive Therapy (ECT) -rarely used.
What feature of Bipolar I is easiest to treat: Mania, depression, or mixed episodes?
Mania is the easiest to resolve with treatment. Mixed/cycling is the hardest.
Is monotherapy or combination therapy preferred for bipolar disorder?
Combination therapy, but it comes with increased risk of side effects.
Do people’s treatment regimen for bipolar disorder usually stay constant or have to be modified?
Usually must be modified.
