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Flashcards in Bipolar Disorder Deck (31)
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1

What is the definition of bipolar disorder?

Spectrum of cyclic mood disorder (think rollercoaster)

2

How do bipolar patients go through sx?

Cycle between depression and mania/hypomania

3

What is the first BD episode in males most likely to be?

Manic episode

4

What is the first BD episode in females more likely to be?

Major Depressive Episode

5

How often are BD patients symptomatic?

Frequently (almost 50% of the time

6

If a patient with BD has co-morbidities, how does that affect treatment?

Requires lots of care and intervention

7

What hypothesis does BD treatment target?

Neurotransmitter hypothesis

8

What are the RFs for BD?

Genetic component = FH (BD, MDD, Suicide)
Stressors (divorce, legal problems, financial problems, substance abuse/use, job loss)
Medications (antidepressants, decongestants, stimulants, EtOH, cocaine, amphetamines, caffeine, corticosteroids)

9

What is the essential feature of BD?

Characterized by the occurrence of manic episodes, hypomanic episodes, or mixed episodes
Often individuals have also had major depressive episodes

10

What is the average age of BD onset?

20 yo

11

What is the average amount of episodes in a 10 year period?

4 episodes

12

What implications does BD have?

Neuropsychologic implications

13

What is rapid cycling?

4 or more mood episodes in a 12 month period

14

Who should be screened for BD?

18-40 yos with RFs
Patients that may describe not feeling like themselves at times

15

What are the tools for psychometric screening?

MDQ

16

What is the criteria for Manic Episodes?

At least 1 week (or any duration of hospitalization)
3 or more GIDDINES sx
Severe enough to cause marked impairment

17

What does GIDDINES stand for?

Grandiose; increased self-esteem
Increased activity (goal directed/highly risk)
Decreased judgement
Distractibility; flight of ideas
Irritability
Need less sleep
Elevated mood
Speedy talking

18

What is the criteria for hypomanic episodes?

At least 4 consecutive days
3 or more GIDDINES sx
Not severe enough to cause marked impairment

19

What is Bipolar Type I?

Mania
Psychosis often present
Impaired functioning
Hospitalization often required
Duration = months

20

What is Bipolar Type II?

Hypomania
No psychosis
Functioning slightly impaired to improved
Hospitalization not required
Duration = weeks

21

What is Cyclothemia?

At least 2 years with periods of hypomanic and depressive symptoms
Does not occur for more than 2 months at a time but is present > 1/2 the time

22

What is mixed BD?

Patient with sx of both mania and depression simultaneously

23

If a patient has severe sx, how does that affect diagnosis?

Typically requires hospitalization and makes diagnosis more difficult
Does not fall under DSM-5 criteria

24

How long do medications take for onset of action or sx improvement?

7-10 days

25

How long do medications take to improve mood symptoms?

4-6 weeks

26

What is DOT for BD?

Typically life long, once diagnosis is made

27

What are 1st line therapies for BD?

Lithium
VPA
AAP/SGA
Consider 2 drug combo (MS + AAP)
CBZ 1st or 2nd line depending on guideline (has FDA indication)

28

What are the 2nd line therapies for BD?

Try a different first line therapy (little to no response)
Consider 2 drug combo (if partial response)
CBZ or OxCBZ (generally not used)

29

What do we use to monitor response/effectiveness of drug therapy in Bipolar/mania?

YMRS

30

What are the first line therapies for acute bipolar depression?

Lithium
Lamotrigine
Quetiapine
VPA
or olanzapine/fluoxetine combo