Flashcards in BIPOLAR Deck (26):
What is the recurrence rate of bipolar? What about in the first year?
90% First year = 50%
What are the 4 subtypes of bipolar disorder?
Mixed mania; Rapid cycling; bipolar II; and Secondary mania
What is mixed mania?
Simultaneous mania & depression
What is rapid cycling?
more than 4 episodes/year
What is bipolar II?
Hypomanis (LESS than 4 days duration; who is functional and extra-alert) that alternates with depression. Never had mania.
What is secondary mania?
Due to an underlying disorder (drugs [steroids], tumor, CVA, SLE, infectious)
Is there a genetic component to bipolar disorder?
Yes (more common in twins)
What are the 2 ways you can figure out if there is a genetic component?
Linkage studies (find the gene within the disorder) & Association studies (compare variations in genes); possibly mitochondria dysfunction
In general, at what age are people diagnosed with bipolar disorder?
Adolescence 13-18 years old (followed closely by early adulthood)
What portion of the brain does bipolar mostly affect?
Anterior Limbic System (prefrontal cortex, amygdala, hippocampus)
On average, a person with bipolar disorder is not diagnosed until when?
Nearly a decade after the onset of symptoms
What are some of the diagnostic challenges of bipolar?
past records (poor prior history); vague diagnostic criteria; lack of validating biological markers; and depression is a common chief complaint during manic episodes
What are the 3 phases of treating bipolar?
Acute; continuation; and maintenance/discontinuation
What’s a difference between schizophrenia & bipolar?
Bipolar is highly functioning
Schizophrenia often declines over time
How much of a person’s like with bipolar disorder is spent in the manic stage?
half of their life
What is a manic episode?
Sleeplessness; look agitates, euphoric, or irritable; buying bulk of things that they don’t need or can’t explain why they have them (can even spend all the money they have – which is where the risk for recurrence)
What is bipolar I?
They have one manic episode (also why it’s hard to treat; if someone has a manic episode at 20 they often forget when they are 50 what it was like and therefore they might not want to treat)
How do you treat acute mania?
Lithium or valproate or antipsychotic (go with the lithium unless they also have psychosis)
Remember tardive dyskinesia are permanent
How do you treat a bipolar patient with depression?
Lithium (can add an antidepressant)
What is the maintenance treatment for bipolar?
Lithium or valproate
Alternatives: lamotrigine, carbamazepine, oxycarbazepine
Atypical antipsychotics can be considered
How long does lithium take to get to full effect?
14 days; which you may need to use a benzo in the mean time
What is an advantage to lithium?
It decreases suicide rate
How do you evaluate mania?
Elevated mood, increased motor activity, irritability, speech, content, disruptive/aggressive behavior
What 3 mood stabilizers, used to treat bipolar, are FDA approved?
Lithium, Depakote, and Lamictal
Any treatment for depressant carries the risk of what in a bipolar patient?