Exam 2 Mood Disorders: Bipolar

Question 1

Manic Episode DSM criteria? (4)

Sxs? (8)

Answer 1

A. Elevated or irritable mood w/ sxs > 1 wk

B. Includes 3 + sxs to significant degree:

1) Distractibility
2) Indiscretions (high risk/consequence activity)
3) Grandiosity
4) Flight of ideas
5) ↑ goal-directed activity
6) Hyperactivity
7) ↓ Sleep
8) Pressure speech (rapid/frenzied)

C. Fxn’l impairment or hospitalization to prevent harm or psychosis

D. Not mixed episode, drugs or GMC

Question 2

Bipolar Affective Disorder: Type I? (3)

Answer 2

A. Current/Recent Manic Episode

B. 1+ previous MDD or Mixed episode

C. Not from Schizo/Delusion/Psychosis

Question 3

Bipolar Affective Disorder: Type II? (6)

Answer 3

A. Current/hx of 1+ MDD

B. Current/hx of 1+ Hypomanic Episode

C. Period of Mania lasting 4+ days including:

1) 3+ Manic sxs
2) Uncharacteristic/Observable ∆ in mood/fxn
3) Not severe enough for hospitalization
4) No psychosis

D. No hx of Mania or Mixed

E. Not from schizo/psycho

F. Not necessarily impaired

Question 4

Hypomanic Episode is? (6)

Answer 4

A. Persistent elevated/irritable mood 4+ days, clearly different from usual non-depressed mood

B. Presence of 3 Manic sxs

C. Uncharacteristic/Observable ∆ in fxn/mood

D. Not severe enough for hospitalization

E. No hx of Manic or Mixed episode

F. No psychosis or schizo

Question 5

Bipolar Affective Disorder DDX? (5)

Answer 5

Borderline
Unipolar Major Depression
Schizoaffective
ADHD
Drugs

Question 6

Bipolar Affective Disorder Type I/II tx:

Manic phase? (2)

Answer 6

Antimanic Stabilizer: lithium or Anticonvulsant: Depakote

AND

Atypical Neuroleptic Antipsych: Abilify, Risperdol, Zyprexa, Seroquel

Question 7

Bipolar Affective Disorder Type I/II tx:

Depressed phase meds?

Supplements?

Other tx?

Answer 7

Antimanic Stabilizer and/or Anticonvulsant
AND/OR
Atypical Neuroleptic Antipsych
AND/OR
Antidepr combo: olanzaprine (Antipsych)/fluoxetine

Omega 3 FA

ECT

Question 8

Bipolar Affective Disorder Type I/II tx:

Maintenance? (3)

Answer 8

Antimanic/stabilizer: lithium

Anticonvulsant: Depakote or Lamictal

Atypical neuroleptic/antipsych: Risperdal

Question 9

Lithium ramp-up period?

Monitor?

Answer 9

5 days

Lithium, TSH, BMP, CBC, PREGNANCY TESTS

Question 10

Lithium s/e? (6)

Answer 10

Tremor
Wgt gain
N/D
Leukocytosis
Hypothyroid
Nephro DI

Question 11

Lithium interacts w/ what meds? (3)

Answer 11

NSAIDs
Antiplatelets (ASA, plavix)
ACE Inhib

Question 12

Valproate/Depakote ramp-up?

Monitor?

Answer 12

3 days

CBC, CMP, Valporic Acid
LFT > 3x N = STOP MED

Question 13

Valproate/Depakote warnings? (3)

s/e? (5)

Answer 13

hepatotoxic
pancreatitis
teratogenic

Wgt gain
GI
Sedation
-penias
Alopecia

Question 14

Lamotrigine/Lamictal approved for?

s/e? (4)

Answer 14

maintenance only

Steve-Johnson
Aseptic meningitis
GI

DECREASED BY BIRTH CONTROL

Question 15

Bipolar Affective Disorder: Cyclothymia is?

Risks?

Tx?

Answer 15

1) Alternating hypomanic/mild depression
2) Doesn’t meet criteria for MDD or BAD
3) Sxs 2+ yrs

Later onset might be MS
Up to 50% get BAD

Mood stabilizers 1st line