Bipolar

Question 1

Types of Bipolar

Answer 1

Bipolar I (BDI)
Bipolar II
Cyclothymia

Question 2

epidemiology & causes

Answer 2

Men = Women
BDII more common in women
onset childhood/adolescence through up to 40s-50s
Genetic component - 1st degree relative - increased rate of BD
comorbid subst abuse
25-50% lifetime risk of suicide attempt

Question 3

Clinical Presentation

Answer 3

Triggered by adverse event/stressor
Manic episode followed by dprssn
Psychotic s&s my be present in acute manic or acute depressive phase
Tx most often sought in depressive phase
May be asymptomatic b/t phases
Assess for hx of manic/hypomanic episodes, past tx, and fam hx

Question 4

Dx criteria:
BD I
BD II
Cyclothymia
BD NOS (Not Otherwise Specified)

Answer 4

BD I - 1 manic or mixed episode, 1 or more major depressive episodes
BD II - 1 hypomanic episodes, no manic episodes; 1 or more depressive episodes
Cyclothymia - numerous episodes of depressed mood - do not meet full criteria of major dprssn, & episodes of hypomania over 2 yrs in adults, 1 yr in kids/adol (15-50% chance of developing BD I or II)
BD NOS - Bipolar features do not meet criteria for BD: unable to determine if s&s r/t primary, med conditions, or subst abuse

Question 5

DIGFAST common behaviors

Answer 5

Distractibility
Insomnia
Grandiosity
Flight of ideas
Activities - increased
Speech - pressured, talkative
Thoughtlessness - sexual indiscretions, wreckless driving, etc

Question 6

Mania Clinical Presentation

Answer 6

Elevated/Irritable mood lasting 1 week
Grandiosity, psychomotor agitation, high-risk behavior, decreased need for sleep, incessant talking, distactibility
Psychotic features - poss danger to others
Marked impairment in occupational or social fxnign

Question 7

Hypomania

Answer 7

Distinct period of elevated, expansive, or irritated mood lasting at least 4 days that is clearly different than nrml nondepressed mood
S&S similar to manic episode - not severe enough to cause occupational/social imparment or hospitalization
No psychotic features

Question 8

Mixed Episode

Answer 8

Nearly every day for at least 1 week, criteria for manic episode and major depressive episode are met simultaneously
Severe occupational or social dysfxn present and may require hospitalization
May have psychotic features
S&S not attributable to subs abuse or underlying med condition

Question 9

Screening: Mood Disorder Questionnaire

Answer 9

Cognitive S&S:
Distractable
Racing thought
Increase in talking

Behvior S&S:
Disinhibition/Impulsive
Less need for sleep

7 or more positive = mod or serious problem

Question 10

Labs to consider

Answer 10

CMP
CBC
TSH
HIV
RPR
Hep C

Question 11

Tx

Goal
Referral
1st line meds

Answer 11

Goal: remission and prevention of future episodes, return to baseline premorbid condition
Refer and collaborate c psych

1st line meds for Mania:
Lithium + anitpsychotic
Valproic + antipsychotic
Adjuvant meds: gabapentin, topiramate, benzos

1st line meds for depressed
Lithium or Lamotragine

Question 12

F/U, Maintenance

Answer 12

Encourage F/U c psych
Review tradeoffs b/t QOL and effects of tx - emphasize importance of maintenance of mood and adherence c meds
If presents c S&S assess for drug-drug interactions, subs abuse, non-adherence
Avoid stimulants - coffee, OTC meds
Avoid ETOH
Encourage regular sleep/wake patterns and regular work/leisure schedules
Safe sex practices
Assess suicide risk
Eval other health concerns r/t meds: metabolic effects, wt gain/loss, HTN, hyperlipidemia