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Flashcards in Bipolar Deck (28):
1

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

2

what tx to avoid in bipolar disorder?

MDD tx --> may exacerbate

3

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

4

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

5

what to think if onset is >50y?

due to medical condition or meds

6

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

7

genetics of bipolar

1st degree relatives: 7x more likely
MZT: 33-90%
DZT: 5-25%

8

neuroimaging of bipolar

enlarged ventricles
frontal lobe white matter lesions
decr gray matter in limbic sys

9

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

10

cortisol levels in bipolar?
cytokines?

incr cortisol
incr pro-inflam cytokines

11

what env changes assoc w mania onset?

sleep disturbance/deprivation
travel changes in time zone
early fall/spring daylight changes

12

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

13

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

14

substances that cause/contribute to mania --> substance/med-induced bipolar d/o

stimulants: cocaine, amphets
antidepressants
glucocorticoids
antibiotics

15

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

16

type of speech, thoughts, and energy?

pressured: loud/rapid/hard to interpret
racing/disorganized (flight of ideas)
high/increased goal-directed activity

17

a manic episode with simultaneous sx of MDE

mixed features

18

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

19

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

20

BP II main features

at least one hypomanic episode
at least one MDE
NEVER a manic episode

21

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

22

acute tx of depressive episodes

NO ANTIDEPRESSANTS w/o a mood stabilizer: lithium, anticonvulsant, antipsychotic (lamotrigine)
psychotherapy
ECT

23

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

24

bipolar co-morbid w?

substance use d/o --> may destabilize mood and result in recurrence

25

psychosocial interventions for bipolar

psychotherapy and psychoeducation promote dec rate hospitalization, decr risk of relapse, improved adherence to meds

a) incr social support, b) teach importance of regulating sleep cycles, c) coping methods for stressful events

26

psychosocial intervention where pts keep track of wake up/eat/first contact/go to sleep

interpersonal and social rhythm therapy

27

what meds for manic & depressive sx?
anti-manics?
meds for bipolar depression?

lithium, quetiapine
lithium/VA/carbamazapine/atypicals/BZDs
lithium, quetiapine, olantrogine/fluoxetine, lamotrigine

28

bipolar ddx

Bipolar I (lasts 7+ days)/II (lasts 4+ days)
substance abuse
depression (2+ weeks)
schizo