Bipolar Disorders

Question 1

disruptive mood dysregulation disorder

Answer 1

a depressive disorder of children with low conversion to bipolar but at risk to develop MDD and/or anxiety d/o as adult

Question 2

disruptive mood dysregulation d/o diagnostic criteria

Answer 2

severe recurrent temper outbursts - verbal or behavioral - out of proportion to provocation, 3+/wk
mood between outbursts is persistently irritable or angry most of day nearly every day for 12+ mos

Question 3

diagnostic criteria: bipolar 1

Answer 3

depressive episode common, manic episode 1+ (req), hypomanic episode common but not req

Question 4

diagnostic criteria: bipolar 2

Answer 4

1+ depressive episode (req), no mania, 1+ hypomanic episode (req)

Question 5

diagnostic criteria: cyclothymia

Answer 5

at least 2 years of hypomanic and depressive sx not meeting criteria for hypomania or depressive episode
sx present at least 50% time, not more than 2 mos w/o sx

Question 6

symptoms of mania

Answer 6

DIGFAST:
Distractability
Insomnia - dec need or desire, w/o fatigue
Grandiosity
Flight of ideas - but make sense
Activity - excessive focus and inability to stop
Speech - pressured
Thoughtlessness/ impulsivity

Question 7

symptoms of hypomania

Answer 7

like mania but not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization; no psychotic features

Question 8

rapid cycling

Answer 8

> 4 episodes of depression, mania, or hypomania in 12 months
episodes demarcated by full or partial remission for 2 most (same pole) or switch to opposite pole
*difficult to treat

Question 9

bipolar vs unipolar depression

Answer 9

bi: late teens-20s, common postpartum, abrupt onset, retardation > agitation, hypersomnia > insomnia, more common: fam hx, substance abuse, psychosis, mania w antidepressant
unipolar - opposite

Question 10

gender influence on bipolar 1

Answer 10

females more likely to rapid cycle and have mixed states
higher comorbidity eating d/o, depressive states, risk of alcohol use d/o
males more likely to have manic episode first, but both more likely to have depressive episode

Question 11

prognosis of bipolar psychosis

Answer 11

after a manic episode with psychosis, more likely to experience psychosis in future manias

Question 12

risk factors for bipolar 1

Answer 12

higher income, sep/ div/ widowed

genetics (fam hx strong - SZ and bipolar 1)

Question 13

onset of bipolar 2 vs 1

Answer 13

2 in mid-20s (later than 1), earlier than MDD

often begins with MDE

Question 14

bipolar 2 episodes

Answer 14

more episodes than MDD or bipolar 1
interval b/t episodes dec with age
MDE more common/enduring w age

Question 15

conversion from bipolar 2 to 1

Answer 15

5-15% pts will ultimately develop mania

Question 16

risk factors bipolar 2

Answer 16

genetic (fam hx BP 2)

rapid cycling - worse prognosis

Question 17

comorbidities in bipolar d/os

Answer 17

65% BP pts have 1+ other psych d/o
75% have anxiety d/o
substance use d/o: 61% - BP1 (50% EtOH, greater suicide risk), 37% - BP2

Question 18

most prevalent comorbidity in BP patients

Answer 18

metabolic syndrome

migraines

Question 19

suicide in BP disorders

Answer 19

completions: BP2 > BP1 > MDD
attempts: BP1 > BP2 > MDD

Question 20

course of cyclothymia

Answer 20

insidious onset in adolescence/ early adulthood

15-50% will develop BP 1/2

Question 21

comorbidity of cyclothymia

Answer 21

substance-related d/o

ADHD (in kids)

Question 22

psychotherapeutic interventions for bipolar d/o maintenance

Answer 22

psychoeducation; IPSRT (interpersonal social rhythm therapy - maintain sleep and activity schedule), CBT, FFT (family-focused therapy)