Sutherland-Bipolar Disorder

Question 1

What are the criteria for bipolar disorder?

Answer 1

1. Depression may or may not have been present in hx

2. Hx of manic episode is ALL that is necessary for diagnosis

Question 2

What is the criteria for mania/ Bipolar I Disorder?

Answer 2

1. Elevated, expansive, irritable mood
2. Distinct period lasting ONE week or more
3. 3 or more sx of: Grandiosity, decreased sleep need, pressured speech, flight of ideas, distractibility, causes impact in usual functioning

Question 3

What is the criteria for diagnosing hypomania/Bipolar II Disorder?

Answer 3

1. Hypomania perceived as a positive experience
2. Sociable, productive, self confident
3. Does not mean impairment in usual functioning
4. Does not meet full mania criteria

Question 4

What are features of manic depression (Bipolar)?

Answer 4

Episodic
Euphoric w/ grandiose delusions
Inter-episode CLEARING

Question 5

What is the prevalence of bipolar? Risk factors?

Answer 5

.8% of pop
Family hx in first/second degree relative
80% concordance in twins

Question 6

What is the difference in duration between mania and major depression?

Answer 6

Mania- 1 week to 6 months
Major depression- 4 wks to 2 years
*Dysthymia + major depression can coexist for years

Question 7

What processes involved with emotional regulation?

Answer 7

1. Attachment- establishing security that enhances self-regulation, temperament
2. Cognitive development- egocentric to empathetic, public to private speech, executive functioning (begins in middle childhood)

Question 8

What are examples of abnormal emotion regulation development?

Answer 8

Reactive attachment disorder
Infants of depressed mothers
FAS
PTSD
Personality disorders

Question 9

What is the neurophysiology of bipolar?

Answer 9

1. Deactivation in the inferior frontal cortex or ventrolateral prefrontal cortex (in manic but NOT depressed states)
2. Limbic hyperactivity

Question 10

What is the urgency of treatment for bipolar?

Answer 10

• suicide rate is >10% in bp and <2% in major depression

- consider inpatient hospitalization

Question 11

What are the two drugs used effectively for suicide?

Answer 11

Clozapine and lithium are the only agents proven have anti-suicide effect

Question 12

What is Occam’s razor?

Answer 12

Don’t need to add additional diagnoses.

Question 13

How do you differentiate ADHD from childhood mania?

Answer 13

Childhood mania:

• elated mood
• grandiosity
• fight/flight ideas/racing thoughts
• decreased need for sleep
• hypersexuality

Question 14

What is a personality disorder?

Answer 14

pattern of rigid response to stress, resulting in some enduring area of disability

Question 15

What cluster most closely resembles bipolar?

Answer 15

Cluster B:
Narcissist
Histrionic
BPD
Sociopath

Question 16

What are the 3 distinct purposes for using meds in pts w/ bipolar disorder?

Answer 16

1. treat or prevent depression
2. treat or prevent mania
3. manage impulsivity/emotional lability irrespective of diagnosis

Question 17

What is the safest tx for pregnant woman w/ mania?

Answer 17

ECT

Question 18

Who should not be given an anti-depressant?

Answer 18

Bipolar I Pt.

only add if they’re on a mood stabilizer

Question 19

What is activation syndrome?

Answer 19

Restless agitation when put on an anti-depressant

Question 20

Lithium carbonate

Answer 20

One of two psychiatric medications that reduces suicidal thought/behavior
-hypothyroidism, renal insufficiency, risk of Li toxicity

Question 21

What are mood stabilizers?

Answer 21

Li
Depakote (divalproex Na)
Carbamezapine

Question 22

Sodium divalproex (Depakote)

Answer 22

Equal to efficacy of Li

-hepatotoxicity, thrombocytopenia

Question 23

Carbamazepine (Tegretol)

Answer 23

Nearly as effective as Li and divalproex

-agranulocytosis, hepatotoxicity