Bipolar Disorder

Question 1

Bipolar I

Answer 1

at least one episode of mania alternating with major depression

Question 2

Bipolar II

Answer 2

one or more episodes of hypomania alternating with major depression

Question 3

mania

Answer 3

severe impairment lasting 1 week that usually requires hospitalization to prevent harm with 3+ symptoms

Question 4

hypomania

Answer 4

change in functioning lasting at least 4 days

reality testing is not impaired and hospitalization is not usually required

Question 5

rapid cycling

Answer 5

2+ episodes of alternating mania/depression in a 12 month period

Question 6

mixed features

Answer 6

depressive symptoms occur during manic episode

Question 7

mania symptoms X7

Answer 7

inflated self/esteem
decreased need for sleep
more talkative
flight of ideas
distractibility
increase in goal directed activity
excessive involvement in activities with high potential for consequences

Question 8

unipolar depression clinical picture

Answer 8

may be present with manic symptoms but they do not meet criteria for diagnostic

Question 9

bipolar depression medication

Answer 9

antidepressants must be used in conjunction with mood stabilizers

Question 10

unipolar depression s/s X5

Answer 10

• affects more women than men
• appears later in life
• loss of appetite
• insomnia
• lesser risk of drug abuse/suicide

Question 11

bipolar depression s/s X5

Answer 11

• affects women and men equally
• onset younger age
• alt binge eating/anorexia
• hypersomnia and difficulty waking
• greater risk of drug abuse/unipolar

Question 12

comorbidities with bipolar disorder

Answer 12

-substance use disorders
-anxiety disorders
-borderline personality
ADHD

Question 13

genetics and biopolar

Answer 13

strong genetic factor

Question 14

neurotransmitters and bipolar

Answer 14

epi and nor epi high in mania and low in depressino

serotonin and dopamine affected too

Question 15

psychosocial factors of bipolar

Answer 15

may be triggered by stress

more prevalent in upper socioeconomic classes

high among writers, artists, highly educated professions

Question 16

acute phase planning

Answer 16

medical stabilization and maintaining safety

potential hospitalization

Question 17

continuation phase planning

Answer 17

relapse prevention via:

medication compliance, psycho-education, referrals, support groups

Question 18

maintenance phase planning

Answer 18

relapse prevention through coping strategies, psychotherapy, recovery/support groups

Question 19

communication

Answer 19

be firm and calm

short and concise statments

clear limit setting

firmly redirect and distract PRN

Question 20

antidepressants and bipolar

Answer 20

should not be given alone - must use mood stabilizers

hypomania/mania may result

Question 21

preferred antidepressants with bipolar

Answer 21

bupropion, venlafaxine or SSRI’s

Question 22

preferred antipsychotics with bipolar

Answer 22

onlanzapine, quetiapine, risperidone, ziprasidone

Question 23

first line treatment bipolar

Answer 23

lithium

Question 24

lithium MOA

Answer 24

alters excitatory neurotransmitters and neuronal activity

Question 25

lithium maintenance level and onset time

Answer 25

0.4-0.1, effects begin in 5-7 days but may take 2-3 weeks for full effect

Question 26

lithium SE X4

Answer 26

hand tremor polyuria nausea weight gain

Question 27

long term risks of lithium

Answer 27

hypothyroidism kidney impairment contraindicated in pregnancy

Question 28

severe lithium toxicity SE X8

Answer 28

``` ataxia EKG changes blurred vision clonic movements polyuria seizures hypotension pulmonary complications ```

Question 29

severe lithium toxicity level

Answer 29

2.0-2.5

Question 30

lithium pt ed X7

Answer 30

monitor blood levels, thyroid, kidney level maintain salt and fluid intake s/s of toxicity do not take diuretcs/OTCs avoid pregnancy take with meals do not stop abruptly

Question 31

mood stabilizers MOA

Answer 31

depresses CNS by increasing GABA

Question 32

mood stabilizers X8

Answer 32

``` divalproex valproate valproic acid carbamazepine lamotrigine gabapentin topiramate oxcarbazepine ```