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What is the DSM Criteria for a Manic Episode?

Abnormally and persistently Elevated, Expansive or irritable mood, lasting at least 1 week and including (3/7) THREE out of SEVEN of DIGFAST symptoms (or 4/7 if irritable mood):
I-Insomnia (a decreased need for sleep)
G-Grandiosity (or inflated self-esteem)
F-Flight of Ideas (or racing thoughts)
S-Speech is pressured (pt is uninterruptible, rapid talking)
T-Thoughtlessness (risky behavior-sexual, financial…)


How is hypomania different from mania?

Hypomania—no marked impairment in functioning, does not require hospitalization, no psychotic features.
Use same criterion as above with 4 days of symptoms.

-hypomania goes with BPAD II


What are some medical reasons for a manic episode?

Metabolic (hyperthyroid), Neurologic (seizures), Tumor, HIV, Syphilis, Steroid Use (Prednisone!), or TCA antidepressants
Methamphetamines and cocaine can cause manic symptoms


Do more women or men get bipolar and how old are they?

onset from childhood-50 years, average age=19y

More common in singles and divorced people

Most common presentation of BPAD is depressive episode


What labs should be ordered in w/u of Bipolar pt?

Chem & CBC, LFT’s, Urine Drug, TSH, B12, RPR, HIV


What is the criteria for cyclothymic disorder?

2 years of symptoms with periods of hypomanic symptoms, depressive symptoms with no more than 2 months of time symptom-free.

-pts may not have MDD, manic or mixed episodes


What is a non-pharmacologic treatment for BPAD?



ECT procedure

Early morning after 8-12 h fast, pts get atropine or another anticholinergic as well as anesthetics before procedure. Stimulus electrodes are placed bitemporally, pts get brief pulse stimuli.


What are the side effects during the ECT procedure?

Increased Intracranial Pressure

Bradycardia which advances to Tachycardia (can be arrhythmogenic)

-absolute CI is increased ICP
-relative CI are=recent MI, large aneurysms, tumors

s/e after=memory loss, HA, confusion


Which of the dementias is the most common?



Which dementia has a stepwise history of progression and a hx of CVD?



Which dementia is associated with visual hallucinations and responds
Poorly to levodopa and may worsen with antipsychotics?

Lewy body


Which dementia is associated with younger patients (usually under 75y)
Who have a major personality change with prominent early behavior changes?



Describe the natural history of Alzheimer’s disease.

More common in women, Age most key risk factor

Slow progressive loss of cognitive function
Early onset is <65 years
Lots of memory problems, later loss of ADL’s
Attention is okay, they will guess for you


Describe the natural history of Vascular dementia.

2nd MC after Alzheimer's, onset may be sudden though

Pts have difficulty w/in 3 months of CVA
Pts have HTN, HL, DM as risk factors
Hx of triggering CV event, stepwise progression

Early difficulty with gait, may have +neuro deficits on exam, neuroimaging w/ infarcts or white matter lesions


Describe natural history of Lewy Body dementia.

1st cognition goes
then More parkinsonian type symptoms

Visual hallucinations

Difficulty with attention, cannot cooperate

Neuroleptics may cause mortality, high rate of EPS s/fx


Describe natural history of frontotemporal dementia.

Pts generally are <65 years (younger)
Pts have behavioral issues (lying, stealing, telling dirty jokes, poor hygiene)
Pts no localized neurologic issue
Memory is generally OK in early course