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Flashcards in Bipolar Disorder Deck (52):
1

What are the characteristics of bipolar disorder?

  • Cyclic mood disorder
  • Extremes of euphoria and depression during episodes
  • Mania and depression
  • May include psychosis, paranoia, hallucinations

2

What is commonly associated with bipolar disorder?

  • Suicide (15%)
  • Alcohol and drug addiction (50%)

3

What are the stages of mania?

  1. Starts pleasant (Euphoria)
  2. Irritability
  3. Paranoia (Think others are jealous of you)

4

What are common symptoms of mania?

  • Irritability
  • Flight of ideas (racing thoughts)
  • Distractability (poor concentration)
  • Hyperactivity
  • Increased, rapid, pressured speech
  • Decreased need for sleep - Red flag

5

Depression in bipolar disorder is (mild/severe).

Very severe

6

(T/F) To be diagnosed with bipolar disorder, you must have mania AND depression.

False. Diagnosis of bipolar disorder occur if patient ONLY has mania.

  • Depression is not a required symptom.

7

What is the average age of onset for bipolar disorder?

21 (college years)

8

Bipolar I is more common in males or females?

Neither. There is equal incidence in both males and females

9

Bipolar II is more common in males or females?

Females > Males

10

How do some bipolar patients act between episodes?

  • Many patients do very well between episodes
    • Hypomania may be helpful in work
    • Psychotic mania predicts poor outcome

11

Depression in bipolar disorder is usually (acute/chronic).

Chronic (can be very severe)

  • Substance abuse (alcohol and drugs) worsens course
  • Suicide in 15% of patients with depression

12

What is secondary mania?

Mania induced from:

  • Drugs (dopamine agonist - cocaine, antidepressants, amphetamines)
  • Medical conditions (brain trauma, HIV, stroke, MS, epilepsy, brain tumor)
  • Medications (steroids - anabolic or glucocorticoids)

13

What is the cause of early onset mania?

Idiopathic bipolar disorder

14

What is the cause of mania onset after 40 years old?

Usually a medical condition or drugs/medications

15

What are some things that cause mania to precipitate?

  • Post-partum state
  • Sleep deprivation
  • Dopamine agonist (amphetamines/L-dopa)
  • Antidepressants
  • Stroke or brain injury
  • Jet lag (especially West to East)
  • Severe life stress

16

What is hypomania?

  • State of increased energy without psychotic symptoms or need for hospitalizatoin
  • Less intense form of mania

17

What type of bipolar diagnosis is made in patients with hypomania?

Bipolar II

18

What symptoms result in classification of mania, not hypomania?

  • Paranoia
  • Delusions
  • Hallucinations

19

Patients are often (aware/unaware) of their mania?

Unaware (feel too good to be an illness)

Family, friends, or the legal system bring it to their attention

20

What is characteristic of Bipolar Course I?

Rapid cycling (4 or more mood episodes per year)

21

What is characteristic of Bipolar Course II?

  • Mainia/depression may last for 4-8 months and remit spontaneoulsy
    • May go years without episodes
    • Depression may be chronic (last years)

22

What is characteristic of Bipolar Depression 1?

  • "Atypical depression"
  • Excessive sleeping
  • Increased eating
  • Suicide risk
  • Teen atypical depression may be first sign of bipolar disorder

23

What is characteristic of Bipolar Depression 2?

  • Often "atypical" features (increased sleeping, eating)
  • May be seasonal (winter depressions, etc.)
  • May have psychosis (hearing voices, delusions)

24

What is characteristic of Bipolar Depression 3?

  • Suicide happens in this phase
  • Hypothyroidism (may result from Lithium use)
    • Symptoms similar to depression
  • Alcohol use may start during this phase

25

What are the side effects of using Lithium to treat bipolar disorder?

LMNOP

Lithium side effects:

  • Movement (tremor)
  • Nephogenic diabetes insipidus
  • HypOthyroidism
  • Pregnancy problems

26

What is characteristic of Bipolar Depression 4?

  • Most patients have more depression than mania
  • Depression more debilitating
  • Treatment more difficult for depression
    • Antidepressant use can push depression into mania

27

What is Cyclothymic Disorder?

  • Presence of hypomanic symptoms  for at least 2 years that don't meet criteria for full hypomanic episode and numerous periosds of depressive symptoms that don't meet criteria for full major depressive episode
  • Results in distress or functional impairment
  • Chronic, smoldering form of bipolar illness (not as severe as bipolar but can progress to it)

28

What is the treatment plan for patients with addiction and bipolar disorder?

  • Must treat addiction and mood disorder
    • Often harder to treat than those with only bipolar

29

What is the Mania Criterion A in DSM5?

A distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistent increased goal directed activity or energy - lasting 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary)

30

What is the Mania Criterion B in DSM5?

  • Inflated self esteem or grandiosity
  • Decreased need for sleep
  • Distractability
  • More talkative than usual, with pressured/rapid speech
  • Flight of ideas or racing thought
  • Increased goal directed behavior or agitation
  • Excessive involvement in pleasurable activities (sex, cars, money) that may have painful results

31

What is a good mnemonic for mania diagnosis during a mental status exam?

DIGFAST (must have at least 3 of 7 symptoms)

  • Distractible
  • Increased activity/psychomotor agitation
  • Grandiosity/Superhero mentality
  • Flight of ideas or racing thought
  • Activities that are dangerous or hypersexual
  • Sleep decreased
  • Talkative or pressured speech

32

What are some soft signs of mania?

  • Large hats on men
  • Multiple rings on men
  • Excessive visible cleavage on women or exposed chest on men
  • Public nudity
  • Public masturbation

33

Compare the Bipolar disorder types and cyclothymic disorder.

  • Bipolar I - Manic episode (see psychosis or need hospitilization), with or without episode of major depression
  • Bipolar II - Major depressive episodes & hypomanic episodes
  • Cyclothymic Disorder - Hypomanic and depressive episodes for at least 2 years that don't meet criteria of full hypomanic or depressive episodes

34

What is the difference between mania and schizophrenia?

  • Mania thoughts are often disorganized, abundant, elaborate, and sometimes playful
  • Schizophrenia thoughts are more bland, fragmented, bizarre with affect less intense

35

What is kindling?

  • Like a seizure disorder (once you have one, the easier is is to have another)
    • Low levels of electrical impulses that start with no effect, then seizures in response to the same impulse
    • Eventually spontaneous seizures follow without impulse
  • Bipolar first related to environmental changes, loss, stress, drugs, sleep deprivation
    • Ultimately autonomous cycling

36

What are classic mood stabilizers for bipolar disorders?

  • Lithium
  • Valproic acid
  • Carbamazepine

37

What are some new options for pharmacological management of bipolar disorders?

  • Aripiprazole, Quetiapine, Risperidone, Ziprasidone, Olanzapine
  • Chlorpromazine (FGA)

38

What is the pharmacological option for treating bipolar-depression?

Fluoxetine-Olanzapine combination

39

What medication is used for maintenence of bipolar disorder and what is a potential risk of using it?

  • Lamotrigine
    • Steven-Johnson syndrome

40

What are the therapeutic levels of Lithium?

0.8 - 1.2 mEq/L (over this amount can be toxic)

41

What is sometimes required at toxic levels of Lithium?

Hemodialysis

42

What are some adverse effects of Lithium?

  • Tremor
  • Sedation
  • Ataxia
  • Aphasia
  • Thyroid enlargement
  • Edema
  • Acneiform skin eruptions
  • Teratogenic: Ebstein anomaly

43

What are the therapeutic levels of Valproate?

50 - 100 μg/mL (over this amount can be toxic)

44

What is the mechanism of action for Lithium?

  • Inosital depletion
  • Glycogen synthase kinase (GSK-3) inhibition
  • Glutamate stabilization

45

What is the mechanism of action for Valproate?

  • Reduction of plasma GABA (GABAeric; increases GABA at cleft)
  • Protein kinase C reduction
  • Glycogen synthase kinase (GSK-3) inhibition

46

What are some adverse effects of Valproate?

  • GI (nausea, vomiting, diarrhea, anorexia)
  • Tremor
  • Sedation
  • Hair loss
  • Pancreatitis (Can kill patient; Black Box Warning)
  • Hepatotoxicity
  • Weight gain
  • Birth defects (Neural tube defects)

47

What is the mechanism of action of Carbamazpine & Oxcarbamazepine?

Voltage gated Na+ and Ca2+ channel blocker

48

What are some adverse effects of Carbamazpine & Oxcarbamazepine?

  • Sedation, dizziness
  • Nausea, vomiting
  • Benign leukopenia
  • Rash
  • Rare Aplastic Anemia, agranulocytosis (do blood work)
  • Steven Johnson Syndrome (Life threatening; very serious)
  • SIADH (syndrome of inappropriate ADH) with hypnaturemia

49

What is the therapeutic levels of Carbamazepine & Oxcarbamazepine?

4 - 12 μg/mL

50

What is the therapeutic levels of Lamotrigine?

None recommended

51

What is the mechanism of action of Lamotrigine?

Voltage gated Na+ and Ca2+ channel blocker

52

What are some adverse effects of Lamotrigine?

  • Sedation, dizziness
  • Nausea, vomiting
  • Benign rash
  • Stevens Johnson Syndrome (Life threatening; very serious)