Bipolar Flashcards
(28 cards)
big chars of mania (need how many of 7?)
descriptors
what is the predominant mood?
what is the cardinal symptom?
need 3+ Distractability Increased activity Grandiosity Flight of ideas Aggitation/irritability Sleep Talking fast
elevated/euphoric, expansive (enthusiasm, conversing w/strangers), irritable, labile affect
irritability
decreased need for sleep
what tx to avoid in bipolar disorder?
MDD tx –> may exacerbate
features of mood disorders
MDD: MDE, rarely mixed features
BP I: MDE (not req), mania, sometimes hypo/mixed
BP II: MDE (required), hypomania, sometimes mixed
epi of bipolar
M:F?
median onset?
4% 3:2, but BP I equal in M/F 25y, men earlier than women completed suicide in 10-15% of BP I 6th leading cause of disability due to non-infectious disease
what to think if onset is >50y?
due to medical condition or meds
2 co-morbid d/o’s with bipolar?
what two signs are a red flag in pts presenting with a depressive episode?
substance use/anxiety
alcohol misuse/panic attacks
genetics of bipolar
1st degree relatives: 7x more likely
MZT: 33-90%
DZT: 5-25%
neuroimaging of bipolar
enlarged ventricles
frontal lobe white matter lesions
decr gray matter in limbic sys
metabolism: ant cingulate v. PFC
NAA levels? lithium’s effect?
up in AC and down in PFC
low levels of N-acetylaspartate in PFC/AC/Hippo
lithium raises NAA by blocking ITP pathway –> release brake on new synapse formation
cortisol levels in bipolar?
cytokines?
incr cortisol
incr pro-inflam cytokines
what env changes assoc w mania onset?
sleep disturbance/deprivation
travel changes in time zone
early fall/spring daylight changes
psychosocial factors in bipolar (families)
families w/high expressed emotion have higher relapse rates
negative life events –> longer recovery and more likely to have new episodes
medical conditions that cause/contribute to mania –> “BP d/o due to another condition”
endocrine (hyperthyroid neuro (MS/huntington/epilepsy) neoplasia (frontal lobe) cerebrovasc disease (right frontal lobe) infection (HIV/AIDS) neurosyphilis herpes encephalitis
substances that cause/contribute to mania –> substance/med-induced bipolar d/o
stimulants: cocaine, amphets
antidepressants
glucocorticoids
antibiotics
how long must episode last to be considered manic? how many required to be considered BP I?
at least 1 week for most of day
one lifetime episode
type of speech, thoughts, and energy?
pressured: loud/rapid/hard to interpret
racing/disorganized (flight of ideas)
high/increased goal-directed activity
a manic episode with simultaneous sx of MDE
mixed features
pt has 4+ mood episodes per year?
what is this assoc w?
rapid cycling
younger age; more frequent depressive episodes; greater risk of suicide attempts
classic is 4 episodes every 10 years
sx for how many days at least to be considered a hypomanic episode?
prominent symptom during hypomanic episodes?
4 consecutive
if there are psychotic features –> its manic
common but not required for BP I
irritability
BP II main features
at least one hypomanic episode
at least one MDE
NEVER a manic episode
acute tx of mania
rapid mood stabilization
LITHIUM is gold std
anticonvulsants: VA and oxcarbazepine
atypical antipsychotics: risper/olanz/quetia/zipras/aripip (IF PT HAS PSYCHOTIC SX)
BZD’s adjuncts for anx/agitation/insomnia
ECT for rapid resolution of severe or refractory depression/mania
psychotherapy NOT effective
take pt off SNRI
acute tx of depressive episodes
NO ANTIDEPRESSANTS w/o a mood stabilizer: lithium, anticonvulsant, antipsychotic (lamotrigine)
psychotherapy
ECT
maintenance treatment of bipolar
kindling: episodes more freq/severe/refractory over time…so primary goal is to REDUCE mood episode recurrence
–> lithium, lamotrigine, VA, atypical apsychs
2/3 pts don’t adhere to first year of tx
bipolar co-morbid w?
substance use d/o –> may destabilize mood and result in recurrence
